Health Worker and Community Experiences in Using the Toll Free Line to Access Maternal and Newborn Health Services in Central Uganda: A Qualitative Study

Abstract

Background: Maternal mortality remains a significant public health challenge in Sub-Saharan Africa which has the highest number of maternal deaths by region. However, most of these deaths are preventable and can be addressed with low cost, effective interventions with an understanding of the three delays associated with maternal morbidity and mortality. In order to address these deadly delays. Save the Mothers (STM) through the Mother Baby Friendly Hospital Initiative (MBFHI) program operates the Toll Free Line (TFL) service that has been influential in addressing the first delay in seeking care. The service, which has been piloted within four health facilities connects vulnerable mothers with quality healthcare facilities at no cost to them. Objective: This study aimed to explore the experiences of health workers and community members in utilising the TFL to access maternal and newborn health services in four health facilities in central Uganda. Method: This qualitative study design employed focus group discussions (FGDs) each with 11 participants. At each of the four pilot health centres, two FGDs were held: one with health workers and another with community members. Each session lasted 45-60 minutes moderated by one STM researcher who utilised a discussion guide with a set of predetermined open-ended questions to facilitate flow of discussion. Interviews were transcribed and translated to English from audio recordings. Data analysis was performed using the framework method and QDA DATA Miner Lite software Results: A total of ten focus group discussions were conducted; two health worker, four female, and four mixed gender. The TFL service was pivotal in improving health worker and community relations, relaying timely health advice, ensuring prompt response to emergency obstetric complications, acted as a referral system and facilitated inquiries on availability of vital medications. However, the service was also hindered by several mischiefs: un-answered calls, language differences, poor connectivity/network and misuse/abuse. Conclusion: The TFL service is a low-cost, high-impact intervention which increases the capacity for health care delivery and can be duplicated in other low resource settings. It empowers community members to make an informed decision to seek care and allows health workers to prepare for incoming emergent labouring mothers thus saving many lives.