Readiness for implementation of preconception care in Uganda; a review on the current policy, health system barriers, opportunities and way forward

Abstract

Background: Uganda like other low-income countries, preconception health has received no attention. Communications in this article are derived from preliminary findings of an ongoing preconception baseline pilot in Luuka-a rural eastern district of Uganda. This is a phased study, including a desk review of literature and a short baseline pilot. Methods: The review followed the methodology of systematic reviews. Key electronic databases were searched including PUBMED/MEDLINE and google scholar. Also, reports from ministries/academic institution libraries and views from experts were done. English articles published post 2000, covering preconception care, barriers, facilitators and policies were included in the review. Out of 110 shortlisted abstracts, 28 were included. Studies were extracted onto structured formats and analysed using the narrative synthesis approach. Results: There exist unstructured preconception health and service guidelines in Uganda. Barriers to preconception service integration into the district’s health system include; lack of a clear policy, careworn health system and care seeker related factors. Opportunities for preconception service integration include; poor maternal and neonatal health indicators, positive change in health seeking behaviour, existence of a gap in the care continuum, functional VHT system to link the community to services, anticipated roll out of key family care practises by Ministry of Health Uganda, and improved access to radio & mobile phones. Conclusion: Formulation of clear preconception guidelines, testing health system integration approaches, stakeholders’ engagement, awareness creation and strengthening the supply side is recommended as a way forward