Health
Uganda Newborn Programme Shifts the Paradigm of Newborn Care
By Joseph Odoi
Every newborn deserves the best start to life. Yet, in Uganda, the burden of newborn morbidity and mortality remains high. The newborn mortality rate stands at 22 deaths per 1000 live births (UDHS 2022). According to most recent UN annual estimates, Uganda records 62,000 deaths around the time of birth. Of these, 32,000 are neonatal deaths, 26,000 are stillbirths and 4,800 are maternal deaths. Majority of the newborn deaths occur within the first week after delivery- a period considered very vulnerable for both the mother and baby.
Uganda’s high fertility rate translates to about 1.7 million births per year; and of these 250,000 babies need special newborn care as they are either born too small or fall sick within the first month of life. This has placed a huge burden on the country and strained the already limited investment for neonatal care.
Despite national efforts, newborn deaths continue to account for nearly half of all under-five deaths in Uganda, according to the Uganda Demographic and Health Survey (UDHS) 2022.
To contribute to addressing this challenge, a coalition of institutions namely; Makerere University School of Public Health, Baylor Foundation Uganda, Adara Development Uganda, Nsambya Hospital, and the Ministry of Health with funding from ELMA Philanthropies launched a national health systems strengthening initiative known as the Uganda Newborn Programme (UNP) in 2022. This program uses a regional approach to improve newborn care in three regions of Uganda namely Kampala, North Central and Western regions.
According to Dr. Monica Okuga, the Uganda Newborn Programme Coordinator at Makerere University School of Public Health (MakSPH), the Uganda Newborn Programme (UNP) made huge strides in providing quality newborn care in 36 health facilities across the three regions of Uganda.
Uganda New Born Programme Achievements
‘’Under the UNP, there have been so far many achievements. Institutional neonatal mortality rate has reduced in the facilities where the program is implemented and this has contributed to overall reduction in neonatal mortality in the regions. For example, Institutional neonatal mortality reduced to 7/1000 and 2/1000 live births by the end of Year 2, down from the baseline rates of 8.4/1000 and 11.9/1000 in Bunyoro and Tooro, representing reductions of 16.7% and 85.3% respectively’’ Dr. Okuga stated.
Dr. Okuga further explained that, ‘’Overall asphyxia case fatality rates across program areas have also reduced from 8.9% to 5%; adherence to infection prevention and control measures has improved across the facilities; and the quality of newborn care provided has also improved.
In addition to revamping many newborn care units, Dr. Okuga revealed that the programme supported the construction of newborn care units, citing Kyegegwa Hospital, Buliisa General Hospital, Masindi General Hospital, and Kyangwali HCIV.
In line with the SDGs programme objectives, specifically SDG 3; Good Health and Well-Being, Makerere University School of Public Health, together with partners including the National Planning Authority (NPA), UNICEF, FHI360, and the Ministry of Health, produced the Situation Analysis of Newborn Health in Uganda-2023 update.
This document has now been taken up by the Ministry of Health and is being used to develop a strategy for implementing the suggested recommendations therein, as well as costing the investment for improving newborn health in Uganda.
The previous newborn situation analysis was conducted 17 years ago in 2008’’ she explained of programme contribution at a multi-sectoral level
Establishment of Uganda’s First Breast Milk Bank
Still under this programme, the first ever Breast Milk bank was established at Nsambya hospital with other donor milk satellite sites at Mengo, Rubaga, Kibuli and Naguru hospitals in Kampala. This donor breast milk has benefited over 275 babies across Kampala and its neighboring districts.
Hospital-to-Home (H2H) Initiative
Another innovation that has been scaled up through the programme is the Hospital to Home (H2H) initiative by Adara Uganda. While many newborn interventions focus primarily on in-hospital care, the Uganda Newborn Programme, in partnership with Adara Development Uganda, pioneered the Hospital-to-Home (H2H) Model, extending its newborn care continuum to the household level. This innovative model ensures that high-risk newborns continue to receive vital support after hospital discharge, addressing the gaps in follow-up care that are common in low-resource settings.
According to Beatrice Niyonshaba, Deputy Director of Maternal, Newborn, and Child Health at Adara Development; “In Uganda, many families struggle to return for follow-up visits due to cost, transport challenges, and lack of caregiver awareness. The H2H model addresses this by involving caregivers early, equipping them with knowledge on newborn danger signs, and ensuring post-discharge follow-up through community health systems like village health teams.”
She adds, “The model not only reduces post-discharge mortality but also builds trust and ownership among families, which is critical but often an overlooked aspect of newborn survival in low-income settings. ‘’We also run regular community sensitization and awareness initiatives about the causes and survivability of small and sick newborns, preventative measures, as well as the services”. The model was initially piloted at Kiwoko Hospital, with strong support from both healthcare staff and the community. This phase allowed for continuous refinement and strengthening of the model, ensuring it met the needs of both families and healthcare providers.’’ Ms. Niyonshaba explained of the H2H Model uniqueness
Currently, the model is being implemented in Nakaseke hospital, a government facility. This will provide insights for scale up to other government facilities. The programme has seen tremendous success due to the engagement and motivation of CHWs, who are provided with incentives, extensive training, and ongoing support. Regular check-ins and monthly meetings ensure these workers remain accountable and connected to the Programme’s objectives.
Challenges in Newborn Care
According to Dr. Monica Okuga and Prof. Peter Waiswa, the Uganda Newborn Programme team lead from MakSPH, in spite of the many achievements, several challenges persist. They explain that many health facilities in Uganda were built without infrastructure to support Newborn Care Units (NCUs). There are no standard floor plans for these units. In many facilities, the neonatal care units are housed in improvised rooms, while in some cases, completely new NCUs are built.
However, even where NCUs are present, they are often let down by an unstable power supply, despite the fact that most equipment in the NCUs require consistent electricity to function. In addition, there are other health system challenges such as insufficient drug supplies from the government, inadequate staffing, and the low involvement of medical officers in neonatal care. Internal rotation of already trained nurses to other units further worsens the situation. Other issues include untimely or late referrals of mothers and babies, as well as challenges with the low quality of data produced in these units.
In terms of lessons learnt while implementing the UNP, The Uganda Newborn Programme team observed and noted several key lessons during the implementation of the programme
- The importance of leadership engagement in the uptake of interventions is very critical. The leaders to be engaged not only include those at the facility level but also those at the district level. The support of political district leaders such as the Chief Administrative Officer (CAO) is also very crucial. One way of engagement is through sharing performance dashboards with key indicators to the District Health Officers (DHOs), CAO, and Health Facility In-charges.
- There is a need for continuous engagement of district leadership for sustainability in public health facilities, especially the human resource aspect for established Newborn Care Units (NCUs).
- There is a need to intervene across the board/spectrum of the health system. Addressing one challenge, for example, the provision of equipment, may not result in the required benefits without addressing human resources and skills.
- Using a regional approach to care, which includes all hospitals and high-volume health centres, is a more rapid and cost-effective way to scale up maternal and newborn care. It also improves access, quality, and referral, thus reducing unnecessary mortality.
- Regional Local Maternity and Neonatal Systems (LMNS) provide avenues/platforms to share lessons and share feedback to teams/facilities on gaps identified.
- Targeted mentorships not only maintain skills but also support teams in innovating for problem-solving.
- Continuous engagement of medical officers in facilities creates buy-in and brings them on board to support and bridge gaps in newborn care in the neonatal care units.
In terms of sustainability, the team stated that the programme’s design took into account the potential for continuation beyond the initial funding from ELMA Philanthropies. From the outset, the Ministry of Health was actively involved in the co-creation of the programme. The programme also made effective use of existing staff and infrastructure to enhance the quality of newborn care. While there was occasional catalytic provisions of drugs and equipment, the programme primarily relied on the government’s drug supply and delivery systems to ensure long-term sustainability.
About The Uganda Newborn Programme (UNP)
The Uganda Newborn Programme (UNP) has been actively working since its launch in July 2022, with the goal of significantly improving the care for small and sick newborns across the country. With support from ELMA Philanthropies, the programme has brought together a consortium of partners, including Makerere University School of Public Health, Baylor Uganda, Adara Uganda, and Nsambya Hospital, in collaboration with the Ministry of Health.
The programme is focusing on 20 high-burden districts across three regions of Uganda ie Western, Kampala, and North-Central, serving approximately 1.5 million births annually. Since its inception, the programme has been making strides in enhancing the capacity of health facilities, including the refurbishment and equipping of 30 specialized neonatal care units. These units are designed to meet the needs of small and sick newborns, in line with the National Essential Newborn Care (NEST) Toolkit.
Key activities that have been rolled out include
- Training and mentorship of Health Workers; More than 800 health workers have been trained and mentored in essential neonatal care practices such as neonatal resuscitation, Kangaroo Mother Care (KMC), Continuous Positive Airway Pressure (CPAP), and infection prevention and control. This has significantly improved the clinical competencies of healthcare providers in the management of small and sick newborns.
- Strengthening Infection Prevention and Control; The programme has focused on improving infection control measures at hospitals, which is critical in managing the high rates of sepsis and other infections among newborns.
- Effective implementation of newborn resuscitation and warm transport: This includes establishing standardized protocols and providing essential equipment like mabu bags plus masks, CPAP machines
- Improving Data Utilization; Efforts have also been made to ensure that health workers are using data-driven evidence for decision-making. Monthly perinatal death audits and support for data quality review have allowed for continuous improvement in service delivery.
- Enhanced Postnatal Care; Community-based postnatal care using Village Health Teams (VHTs) being trained to conduct home visits for newborns discharged from neonatal units. This helps ensure that infants receive timely follow-up care in the critical days after discharge.
The programme is set to run up to July 2025, and by then, it aims to have reached 120,000 small and sick newborns, helping to reduce newborn mortality by 40% in the target regions.
Makerere University and the Aids Healthcare Foundation (AHF) Uganda Cares on July 30, 2025 held a meeting focused on establishing and strengthening collaboration between the two institutions in the fight against HIV/AIDS. The collaboration will particularly focus on prevention and care services for the University’s student population.
Speaking at the event, the Deputy University Secretary, Mr. Kizito Simon who presided over the meeting mentioned that Makerere University is involved in human capital development, aiming to create a healthy population alongside an educated one. “It’s not only good to have an educated population, but a healthy population as well,” he noted.
Mr. Kizito stated that the government supports various interventions in HIV prevention, care, and treatment, with the Makerere University Infectious Diseases Institute (IDI) playing a leading supportive role. On this note, he encouraged AHF Uganda Cares to equally come on board in order to strengthen the fight against HIV/AIDS.
The Deputy University Secretary outlined the Makerere University strategic plan’s prioritization of engagement and partnerships with various sectors, including ministries, departments, agencies, international organizations, civil society, and the private sector in order to strengthen its research-led aspirations. He therefore encouraged Uganda Cares to support HIV AIDS services, including prevention, care, and treatment, and to collaborate in research and innovation, especially with faculty members already engaged in HIV AIDS-related research.
However, he highlighted the demographic vulnerability of Uganda’s young population, with 73.2% aged between zero and thirty years old, making them a high risk group for infections. “This is more than just a time bomb for all of us here, because this is the population which we are hoping to be productive in the later years,” he pointed out.
Mr. Kizito expressed appreciation for the wellness clinic initiative, which is poised to provide accessible sexual reproductive health services to students at no cost. On this note, he stressed the need to publicize these services to ensure students are aware of the available resources and are supported to overcome shyness and reluctance to seek help.
The 91st Guild President Makerere University, H.E. Ssentamu Churchill James with concern noted the increasing levels of irresponsible behavior among young people, which has led to the high risk of contracting STDs, and welcomed initiatives proposed by AHF Uganda Cares.
He further highlighted the recent concluded HIV awareness campaign with Guild Leaders and the Director of the Makerere University Hospital. The campaign was aimed at educating students about HIV and other STDs, emphasizing the importance of knowledge and awareness.
H.E. Ssentamu pointed out that the first year students who are soon arriving on Campus are a key target audience for these awareness efforts. He stressed the importance of abstinence but also emphasized the need for protection in case of emergencies.
The 91st Guild President suggested the possibility of counseling for those who have already contracted STDs. “I hope we can have an attachment of counselling for people that have already contracted diseases,” he stated.
He took note of existing efforts such as the government’s stock of contraception and the presence of health ministers at every hall of residence. In this regard, he proposed a linkage between the initiative and these health committee members through the Guild Minister of Health Affairs to ensure continuity.
The National Medical Director-AHF Uganda Cares, Dr. Lubanga Augustine expressed gratitude for the opportunity to discuss collaboration with Makerere University. He particularly noted previous collaborations and the need to seize opportunities for future collaboration.
He highlighted that AHF Uganda Cares provides cutting-edge medicine regardless of the patient’s ability to pay and advocates for conducive policies to increase access to HIV and STI services.
Dr. Lubanga emphasized the importance of addressing the gap in young people’s access to health services particularly for sexual health issues. He noted that even parents and guardians often avoid discussing sexual issues contributing to a lack of education awareness among young people.
He pointed out that funding for HIV prevention has shifted towards treatment despite the need for continued prevention efforts. In this, he called for increased advocacy and partnerships to secure funding for health services particularly for young people. He appreciated past interventions such as installing condom dispensers in hostels and the need for renewed partnerships with university leaders.
Dr. Lubanga expressed willingness to collaborate with the University Hospital to ensure that no one is left behind in HIV and STI services. As a sign of their commitment, AHF Uganda Cares handed over condom dispensers and condoms to the university.
Dr. Byamugisha Josaphat, Director at the Makerere University Hospital emphasized the importance of prevention in health, through programs such as STI prevention, HIV early treatment, and health education “Prevention is better than cure,” he said. He highlighted that the hospital has got satellite clinics at the Makerere University Agricultural Research Institute Kabanyolo (MUARIK) and the Jinja Campus, serving a significant number of students, staff and the public.
The Director discussed the need for health education and information materials, including pamphlets and WhatsApp messages, to educate students and the public about HIV. “The university is already running health education programs for students and surrounding communities,” he stated.
Dr. Byamugisha further highlighted the importance of male circumcision as a preventive measure against HIV, which is already being offered at the university hospital. “We are aware that safe male circumcision can prevent about 60% of male HIV,” he explained.
He talked about the need for supplies and human resources for screening, emphasizing the importance of protecting the university community and surrounding areas. “The university hospital aims to go beyond just serving students but also help the broader community,” he added.
The Hospital Director emphasized the importance of peer-to-peer interaction between students and staff to enhance health education and support as this could help the students open up more on sexual issues which may not be the case with a person who is older than them. He further explained students undertaking internship at the Makerere University Hospital already have the advantage of easily talking to the staff about these issues.
Dr. Byamugisha highlighted the need for post-exposure prophylaxis (PEP) drugs and counseling, ensuring that people understand the importance of taking these drugs. He suggested specific targets for collaboration, such as supporting a medical officer and providing services rather than cash. “Many a time we don’t need cash, we need in-kind support through a person or provision of a service,” he stated.
In his final remarks, he appealed for support to make services more accessible to students and reiterated the importance of collaboration to protect students and the broader community.
The Deputy Principal, College of Engineering, Design, Art and Technology (CEDAT)-Prof. Kizito Maria Kasule, highlighted that 75% of young people contracting HIV are between the ages of 14 and 24, indicating a need for targeted prevention efforts.
He pointed out the poverty among girls as a significant issue contributing to the spread of HIV because they look at the sexual related practices as means of earning a living which has led to the high spread of these infections.
Prof. Kasule emphasized the importance of involving different religious institutions to sensitize people about the organization’s work and counteract negative perceptions. He suggested that the organization should collaborate with various religious institutions. “Even Born Agains are involved in the sexual relationships but cannot come out to express themselves,” he added.
He stressed the importance of open discussions about gender and sexuality free from fear and trouble, and he raised the need for sensitization within and outside the institution.
Coordinator of the HIV program at AHF Uganda Cares, Mrs. Mbabazi Martha, introduced the girl’s act program which aims to empower young women to address issues affecting them at various levels, from primary school to national policy. “The program encourages young women to raise their voices and influence policies that affect their lives,” she commented.
She highlighted the success of the program in engaging young people and influencing policy changes at different levels of governance, such as the distribution of sanitary pads in schools and communities.
Mrs. Mbabazi emphasized the importance of skilling centers for young girls to gain economic independence and avoid exploitation. She highlighted the success of webinars and dialogues in raising awareness and influencing behavior change. In closing, she called for continued collaboration with various stakeholders to support the empowerment of young people and address the root causes of HIV infection.
Mr. Amojong Trevor, a representative from AHF Uganda Cares, introduced the “Boys to Men” initiative program to address poor health seeking behavior and lack of testing among boys. He emphasized that the need to empower girls should go hand in hand with focusing on boys to prevent the spread of HIV.
He mentioned the low demand of female condoms and suggested demonstration on how to use them to increase awareness and usage.
About AHF Uganda Cares
Aids Healthcare Foundation (AHF) Uganda Cares an NGO based in the USA operating in 47 countries, including 14 in Africa. AHF Uganda Cares started in 2002 in the Masaka region and now operates in 32 districts with over seven health facilities. The organization supports over 203,000 lives on HIV treatment and has tested over 7 million Ugandans for HIV.
The organization offers HIV prevention services, including the ABC (Abstinence, Be Faithful, Condom) approach, and provides about 6 million condoms annually.
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