Quality Improvement Reports

Introducing criteria based audit into Ugandan maternity units

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7427.1329 (Published 04 December 2003) Cite this as: BMJ 2003;327:1329
  1. Andrew D Weeks, visiting lecturer (aweeks{at}liverpool.ac.uk)1,
  2. Godfrey Alia, senior house officer1,
  3. Samuel Ononge, research assistant1,
  4. Alice Mutungi, reproductive health adviser2,
  5. Emmanuel O Otolorin, reproductive health adviser2,
  6. Florence M Mirembe, head of department1
  1. 1Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda
  2. 2Regional Centre for Quality of Health Care, Makerere University, Kampala
  1. Correspondence to: A D Weeks, Department of Obstetrics and Gynaecology, Liverpool Women's Hospital, Liverpool L8 7SS


    Problem Maternal mortality in Uganda has remained unchanged at 500/100 000 over the past 10 years despite concerted efforts to improve the standard of maternity care. It is especially difficult to improve standards in rural areas, where there is little money for improvements. Furthermore, staff may be isolated, poorly paid, disempowered, lacking in morale, and have few skills to bring about change.

    Design Training programme to introduce criteria based audit into rural Uganda.

    Setting Makerere University Medical School, Mulago Hospital (large government teaching hospital in Kampala), and Mpigi District (rural area with 10 small health centres around a district hospital).

    Strategies for change Didactic teaching about criteria based audit followed by practical work in own units, with ongoing support and follow up workshops.

    Effects of change Improvements were seen in many standards of care. Staff showed universal enthusiasm for the training; many staff produced simple, cost-free improvements in their standard of care.

    Lessons learnt Teaching of criteria based audit to those providing health care in developing countries can produce low cost improvements in the standards of care. Because the method is simple and can be used to provide improvements even without new funding, it has the potential to produce sustainable and cost effective changes in the standard of health care. Follow up is needed to prevent a waning of enthusiasm with time.


    • Contributors ADW had the original idea for the work, supervised the project, chaired the project management committee, and wrote the paper. GA carried out the pre-eclampsia audit and implemented the changes. SO coordinated the audit project. AM and EOO advised on audit methods and the logistics of implementation. FMM had overall supervision of the implementation of the changes. All authors were part of the project management committee, taught the methods, and passed the final draft of this paper. ADW is guarantor for the study.

    • Funding This project was funded by the Rockefeller Foundation through the Makerere University capacity building programme for decentralisation (I{at}mak.com).

    • Competing interests None declared.

    View Full Text

    Log in

    Log in through your institution


    * For online subscription