ArticleBMC pregnancy and childbirth2026
Impact of a surgical sponsorship program on compliance with decision-to-delivery intervals in rural hospitals in Uganda.
Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAn emergency caesarean section is a critical intervention to reduce maternal and fetal risks during labour complications. The decision-to-delivery interval, recommended internationally of seventy-five minutes or less, is a key indicator of quality in emergency obstetric care. In rural western Uganda, this interval is often prolonged due to financial and infrastructural barriers. This study evaluated the impact of a sponsorship program's case management and documentation procedures on compliance with the decision-to-delivery interval in a rural hospital setting.
methodsA retrospective cross-sectional study was conducted from January 2020 to December 2023 across four comprehensive emergency obstetric care hospitals in southwestern Uganda: Ibanda, Nyakibale, Rushoroza, and Rwibaale. Data were extracted for all emergency caesarean section cases with indications in categories one and two. Documentation rates and compliance with the decision-to-delivery interval (defined as less than seventy-five minutes) were analyzed using descriptive statistics, trends, and stratified graphs. The study sample compared data from non-sponsored and sponsored patients covered by a financing program offered by African Mission Healthcare, a not-for-profit organization working in Africa.
resultsSurgical Access for Everyone-sponsored patients consistently demonstrated higher documentation rates for the decision-to-delivery interval (70-80%) compared to non-sponsored patients, especially from 2021 onwards. By the fourth quarter of 2023, documentation in both groups exceeded 75%. All facilities showed a reduction in the median decision-to-delivery interval over time, with Rushoroza and Rwibaale achieving the most significant declines to below 60 min by 2023. Compliance with the decision-to-delivery interval of less than 75 min improved from 30% in 2020 to nearly 70% in 2023. Facility-specific trends revealed overall improvement, with Rushoroza and Rwibaale showing the most significant progress by 2023, while Ibanda exhibited the slowest progress.
conclusionThe Surgical Access for Everyone sponsorship program and its required case management and documentation procedures enhanced compliance with the decision-to-delivery interval in emergency obstetric care, demonstrating benefits for both sponsored and non-sponsored patients. Sustained improvements highlight the importance of structured funding and oversight. To maintain and expand these gains, targeted facility-level interventions, strengthened data systems, and continued investment in clinical training are recommended.
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