Mubende District: A perfect location for the ITW program.
Mubende District is serving primarily a large rural based population of subsistence farmers. Most pregnant women in the district live very far from a referral hospital where they can get c-section and advanced delivery services if needed. Therefore, this is the perfect location for the ITW program. The goal is to integrate antenatal ultrasound services at the point of care at the rural lower level health facilities (HC IIIs) in the village near where they live. Training midwives, nurses and clinical officers to do a basic antenatal scan at the point of care (peer reviewed remotely at Mubende Hospital for Quality Assurance) allows women and their husbands to know about complex or critical conditions, like twins, breech presentation, placenta previa, and IUGR well in advance of delivery so they can get to the next appropriate steps in time. Based on findings at our initial pilot site with data gathered from 2010-2012, ultrasound found significant problems in a quarter of pregnant women scanned, requiring a change in management of their care.
With input from the Mubende District Chief Administrative Officer and the District Health Officer, Kasambya HCIII was chosen as an ideal site because of its need. The clinic is 32 km from Mubende Hospital and completes over 700 antenatal visits (ANCs) per month. The population is poor, consisting of peasant farmers and many wives of soldiers who live at the nearby military barracks. Most do not have the time or financial means to travel long distances, so getting a definitive diagnosis by ultrasound near where they live will help everyone to plan better, to help the midwives do better skilled deliveries with information from the scan and to help the patients make better health care decisions or save up for transfer to the referral hospital if a complex problem is detected.
The program has gained good support from the health centre administration as well as from the community and district leaders, who were present for the go-live this week. Their help with community sensitization and educational outreach (a pillar of ITW) will be crucial to the extension and uptake of the program in this area.