Building on momentum from the global campaigns: an exploration of factors that influenced prioritization of stillbirth prevention at the national level in Uganda

Abstract

Background Of the close to 2.6 million stillbirths that happen annually, most are from low-income countries where until recently policies rarely paid special attention to addressing them. The global campaigns that followed called on countries to implement strategies addressing stillbirths and the adoption of recommendations varied according to contexts. This study explored factors that influenced the prioritization of stillbirth reduction in Uganda. Methods The study employed an exploratory qualitative design adopting Shiffman’s framework for political prioritization. Data collection methods included a document review and key informants’ interviews with a purposively selected sample of 20 participants from the policy community. Atlas. Ti software was used for data management while thematic analysis was conducted to analyze the findings. Findings Political prioritization of stillbirth interventions gained momentum following norm promotion from the global campaigns which peaked during the 2011 Lancet stillbirth series. This was followed by funding and technical support of various projects in Uganda. A combination of domestic advocacy factors such as a cohesive policy community converging around the Maternal and Child Health cluster accelerated the process by vetting the evidence and refining recommendations to support the adoption of the policy. The government’s health systems strengthening aspirations and integration of interventions to address stillbirths within the overall Maternal and Child Health programming resonated well. Conclusions The transnational influence played a key role during the initial stages of raising attention to the problem and provision of technical and financial support. The success and subsequent processes, however, relied heavily on domestic advocacy and the national political environment, and the cohesive policy community.

Health workers’ social networks and their influence in the adoption of strategies to address the stillbirth burden at a subnational level health system in Uganda

“…Subnational health systems adopted policy priorities highlighted at the national level in a bid to address stillbirth in Uganda after global campaigns guided national level efforts which gained momentum after 2011. Additional material regarding the applied methodology has been published elsewhere [21,22].…”

“…The ENAP target for countries aimed to reduce the rate by at least 12/1000 or less by 2030. The current trend reflects the improved performance of this particular indicator which stands at 9/1000 facility-level live births [20,21]. Despite this positive trajectory, emerging evidence also suggests that most stillbirths are currently occurring from within health facilities.…”

Examining the variations in the implementation of interventions to address stillbirth from the national to subnational levels: experiences from Uganda

“…Details about the study design have been explained elsewhere [ 3 , 24 ]. Briefly, the study adopted a qualitative case study design.…”

“…Interviews were recorded using a digital audio recorder, with field notes taken during the process. Overall interviews lasted between 45 minutes and 1 hour, and the interview guides used have been explained elsewhere [ 3 , 24 ]. At the national level, two call-backs would be made before a potential respondent would be replaced, while at the subnational level, none of the contacted potential respondents declined to participate.…”

“…Low-income countries typically constrained by resource limitations are disproportionately affected. Within Uganda, stillbirth burden stands at 9/1000 live births, with many categorized as fresh stillbirths reflecting deficiencies in the quality of maternal healthcare, especially around the time of delivery [ 3 ]. To address the challenge, tremendous progress stemming from the Millennium Development Goals (MDG) era has registered success in reducing perinatal mortality and continues to be pursued under the Sustainable Development Goals (SDGs), specifically goal 3.2 [ 4 ].…”