Landscape analyses of gaps in reproductive, maternal, newborn, child, and adolescent health policies and guidelines to catalyse policy implementation improvement in Uganda.

backgroundDespite many improvements in maternal, newborn, sexual, and reproductive health (RMNCAH) in sub-Saharan Africa, the overall progress remains inadequate and uneven. Some of the reasons for this include fragmented healthcare systems, gaps in evidence-based policy, inadequate investment and funding for health, and weaknesses in policy dissemination and implementation. Current stakeholder views on RMNCAH policy formulation and policy implementation in Uganda has not been exhaustively studied to help inform adjustments in policy formulation approaches and implementation strategies. The objective was to conduct a situation analysis to identify gaps in RMNCAH policies and guidelines formulation, dissemination, and implementation in Uganda to be able to recommend strategies to address these gaps, and catalyse policy formulation and implementation.

methodsThis was an exploratory qualitative study conducted among RMNCAH stakeholders at central level and four district local governments in Uganda. Data were collected through review of RMNCAH policies and guideline documents using a document review guide, two guided small-group discussions (SGDs) with central government stakeholders and partners, four SGDs with district health teams (DHTs), eight key informant interviews (KIIs), and four focus group discussions (FGDs) with women 20-35 years of age. The interviews and group discussions were conducted using pretested interview guides, audio-recorded and transcribed verbatim. The transcripts were analysed by thematic analysis using open code software.

resultsIt was established that the policy and guideline documents addressing most of RMNCAH components existed. However, the indicators have not improved adequately to meet the international targets. The main policy implementation gaps reported revolved around policy leadership and coordination such as weaknesses in district and facility leadership and management, insufficient monitoring and evaluation, inadequate community engagement in policy formulation and implementation, inadequate policy and guidelines dissemination, limited multisectoral approach, and insufficient resource allocation to implement the policies and guidelines.

conclusionPolicies and guidelines covering all RMNCAH components are in place, but implementing and translating these into improved indicators has been the major challenge. A strategic framework should be developed to test interventions to address these gaps to catalyse policy implementation in selected districts and later be rolled out to cover the whole country to cause wholesome policy impact.