Once the analysis is completed, Life For Mothers will begin planning Phase II of the pilot project. The results attained from the initial data collection in Phase I will guide our planning process and help us determine what types of methods will enable us to attain our goal of reducing infant mortality through improved family planning and antenatal care.

To keep up-to-date on Life for Mothers planning phases and projects, be sure to keep checking our blog and sign up for our newsletter at our website.

By CELIA W. DUGGER

About 80 percent of the world's maternal deaths occur in just 21 nations, 15 of which are in sub-Saharan Africa, according to a 2010 study on maternal mortality by the University of Washington. Uganda was among them. About 5,200 women died from pregnancy related causes here in 2008, the researchers estimated.

ARUA, Uganda — Jennifer Anguko was slowly bleeding to death right in the maternity ward of a major public hospital. Only a lone midwife was on duty, the hospital later admitted, and no doctor examined her for 12 hours. An obstetrician who investigated the case said Ms. Anguko, the mother of three young children, had arrived in time to be saved.

Her husband, Valente Inziku, a teacher, frantically changed her blood-soaked bedclothes as her life seeped away. “I’m going to leave you,” she told him as he cradled her. He said she pleaded, “Look after our children.”

Half of the 340,000 deaths of women from pregnancy-related causes each year occur in Africa, almost all in anonymity. But Ms. Anguko was a popular elected official seeking treatment in a 400-bed hospital, and a lawsuit over her death may be the first legal test of an African government’s obligation to provide basic maternal care.

As the United States and other donors have given African nations billions of dollars to fight AIDS and other infectious diseases, helping millions of people survive, most of the governments have reduced their own share of domestic spending devoted to health, shifting to other priorities.

It also raises broader questions about the unintended impact of foreign aid on Africa’s struggling public health systems. As the United States and other donors have given African nations billions of dollars to fight AIDS and other infectious diseases, helping millions of people survive, most of the African governments have reduced their own share of domestic spending devoted to health, shifting to other priorities.

For every dollar of foreign aid given to the governments of developing nations for health, the governments decreased their own health spending by 43 cents to $1.14, the University of Washington’s Institute for Health Metrics and Evaluation found in a 2010 study. According to the institute’s updated estimates, Uganda put 57 cents less of its own money toward health for each foreign aid dollar it collected.

Rogers Enyaku, a finance expert in Uganda’s Health Ministry, disputed the assertion, saying the country’s own health spending had increased, “but not that substantially.” Still, the government set off a bitter domestic debate this spring when it confirmed that it had paid more than half a billion dollars for fighter jets and other military hardware — almost triple the amount of its own money dedicated to the entire public health system in the last fiscal year.

Poor people surged into Uganda’s public health system when the government abolished patient fees a decade ago. Increasingly, African countries are adopting similar policies, and experts say that many more people are getting care as a result. But Uganda’s experience illustrates the limits of that care when a system is poorly managed and lacks the resources to deliver decent services, experts say.

A woman in labor rested in the maternity ward at Arua Hospital. At regional hospitals like this one, more than half the positions for doctors are vacant, part of a broader shortage that includes midwives and other health workers.

At regional hospitals like the one here in Arua, more than half the positions for doctors are vacant, part of a broader shortage that includes midwives and other health workers. A majority of clinics and hospitals reported regularly running out of essential medicines, while only a third of facilities delivering babies are equipped with basics like scissors, cord clamps and disinfectant, according to a 2010 Health Ministry report.

The hospital where Ms. Anguko died handles obstetric emergencies for a region of almost three million people, but it recently had no sutures in stock to sew up women after Caesarean sections. Dr. Emmanuel Odar, the hospital’s sole obstetrician, said that even in childbirth emergencies, families must buy missing supplies themselves, typically at nearby pharmacies. Patients without money must beg or borrow it, Dr. Odar said.

“We are overwhelmed with cases of people looking for free services, and they expect a lot despite supplies not there, human resources lacking and the beds not enough,” he said.

Dr. Olive Sentumbwe-Mugisa, a Ugandan obstetrician and adviser with the World Health Organization, participated in the Health Ministry’s investigations of the deaths of both Ms. Anguko and Sylvia Nalubowa, a second woman named in the lawsuit against the government, and concluded that both women arrived in time to be saved.

“We are in a state of emergency as far as maternal services are concerned,” Dr. Sentumbwe-Mugisa said. “We need to focus on the quality of care in our hospitals and address it in the shortest period of time. That will mean more resources. We cannot run away from that.”

In its lawsuit filed in March, the Center for Health, Human Rights and Development, a Ugandan nonprofit group, contended that the government violated the two women’s right to life by failing to provide them with basic maternal care.

The attorney general’s office replied that the “isolated acts” cited in the case “cannot be used to dim the untiring efforts in the Health Sector.” It also noted competing priorities for “the meager resources at the state’s disposal.”

But the government has come in for tough questioning since April, when its spending on the Russian-made fighter jets became public, helping fuel protests.

Officials in President Yoweri Museveni’s government say the jets are critical to protecting Uganda in a region with a history of conflict, especially as the country develops its oil fields. “The enemies of Uganda don’t want us to have those jet fighters,” said Tamale Mirundi, a spokesman for Mr. Museveni.

But opposition leaders denounced the spending in a nation at peace, with huge social needs.

“You are talking about investing in jets? Come on!” exclaimed Christine Bako, a lawmaker from Ms. Anguko’s district, during a debate in Parliament. “This is now a matter of conscience.”

As her due date approached, Ms. Anguko left her village to live with relatives near the big hospital in Arua, 300 miles northwest of the capital, Kampala. In preparation, she and her husband bought the supplies they knew the hospital lacked: latex gloves, cotton wool, a razor blade to cut the umbilical cord.

On a Sunday morning last year, after praying in church, Ms. Anguko felt abdominal pains and went to the hospital. That afternoon, her husband, standing just outside the ward, heard her urgently calling. She told him that she was bleeding and that no one was attending to her, he said. He and his wife’s cousin, Jane Adiru, 33, said they repeatedly approached the nurses for help over the following hours, but were ignored.

The hospital’s own account depicted a nightmarish day of complicated emergencies with only one midwife for both the day and evening shifts. Women arrived with ruptured uteruses, a stillbirth, an obstructed labor, an incomplete abortion and a bleeding cancer of the cervix.

The lawsuit also raises broader questions about the unintended impact of foreign aid on Africa's struggling public health systems. Nurses and a relative attended to an expecting mother at Arua Hospital, where Mrs. Anguko died.

No doctor examined Ms. Anguko until about 12 hours after she was admitted, according to the hospital’s own account. Another hour passed before she finally got into surgery. By then it was too late. She and the baby died.

“Arua Hospital is not happy with what happened and regrets the whole thing,” the hospital’s superintendent wrote to angry leaders of the district council on which Ms. Anguko had served.

As Africa’s population swells, so will demand for emergency obstetric care. The United Nations recently estimated that Uganda’s population will almost triple to 94 million by 2050, with tens of millions more babies to be delivered.

As it is, about 80 percent of the world’s maternal deaths occur in just 21 nations, 15 of which are in sub-Saharan Africa, according to the University of Washington study. Uganda was among them. About 5,200 women died from pregnancy-related causes in the country in 2008, the researchers estimated.

Dr. Rafael Lozano, a professor at the university, said that except for recent gains in saving the lives of H.I.V.-positive pregnant women with antiretroviral treatments largely financed by donors, “you see basically almost no progress in maternal deaths in Uganda.”

When Ms. Nalubowa, 40, a peasant farmer and a mother of seven, arrived at the decrepit hospital in Mityana, said her mother-in-law, Rhoda Kukkiriza, nurses demanded a bribe of about $24 and more money to buy airtime for a cellphone call to the doctor, accusations the nurses have denied. Ms. Kukkiriza said she had less than a dollar left after spending $2.40 to buy a razor blade, gloves and other items the hospital lacked. Unable to pay the bribe, Ms. Nalubowa was taken to the maternity ward and left unattended, her mother-in-law said.

“As she pushed with the labor pains, all that came out was blood,” Ms. Kukkiriza said. “Sylvia called out, ‘I’ll sell all my pigs, I’ll sell my chickens, my goats — please, nurses, come help me.’ ”

Even if a doctor had arrived promptly, the hospital staff would have struggled to save Ms. Nalubowa, who bled to death. Dr. Vincent Kawooya, the hospital’s medical superintendent, said there was only one small unit of blood for a child in stock that night.

The health minister himself toured the hospital after Ms. Nalubowa’s death incited demonstrations, but Dr. Kawooya said the minister refused to set foot in the operating room, with its moldy walls and leaky ceiling, saying it should be condemned. The roof of the maternity ward was a home to bats, and droppings come down its inner walls.

Vincent Nyanzi, a governing party lawmaker from the area, said he introduced Ms. Nalubowa’s mother-in-law and husband to President Museveni when he visited a nearby district.

The president’s secretary gave them an envelope containing about $190, the family said. In their brief audience with the president, Ms. Kukkiriza said, he told them: “ ‘I’m sorry. It’s really a pity.’ ”

A project was undertaken to verify various baseline need assessments, prior to implementing a holistic strategy for improving maternal/neonatal health (MNH). Simultaneously, we created an electronic health database by enrolling 1600 women of reproductive age (WRA) and their families. The use of a cell phone network and mHealth technology affirmed the value of gathering real-time data by the community health workers (CHWs) and overcoming communication gaps between community residents and the health center.

To test our initial hypotheses, we recruited and trained 50 CHWs from 25 villages from Busujju County in Mityana. A 10-day intensive workshop was conducted for CHWs in FP, HIV/AIDS, MNH, and child survival.  The initial pilot was completed in three weeks with 5500 residents registered.

The data revealed huge gaps in health delivery including the lack of HIV testing (70%) and FP (86%) in WRA who were never pregnant. Pregnant WRA also lacked postnatal care (79%) and mosquito nets (39%). 91% of children under 5 were never tested for HIV, 27% were not fully immunized and 46% did not use any mosquito nets. 46% of husbands/partners never used condoms, 70% were never counseled on FP, 43% were not tested for HIV, 66% of them did not attend antenatal care with their wives, and lastly 52% did not use any mosquito nets.

The realistic portrait indicates major gaps in health delivery. Our hypothesis is that CHWs using mHealth technology to monitor patients in real time will improve outcomes facilitating a cost-effective, replicable and sustainable model to strengthen health systems.

Additional data analysis is forthcoming and will be made available on the website and be submitted for publication.

The 25 VHTs continued the intensive HIV/AIDS/Family Planning training course with AIC which began on Friday, March 11th. AIC affiliates led the training. As with the previous training days, lunch was provided and once training had finished, the VHTs were compensated for their travel expenses. I later met with software programmers regarding openxdata.

Lunch Held for Trainees

VHT HIV/AIDS Training

Hon. Sylvia Ssinabulya speaks at VHT training session

Tuesday, March 15th

VHT Training Session

Wednesday, March 16th

Family Planning/Reproductive Health Training

Thursday, March 17th

Friday, March 18th

Tuesday, March 8th
Tuesday was International Women’s Day, a national holiday in Uganda. I spent the day with Wini orienting her regarding LfM’s work in rural Uganda and her responsibilities as the new Program Manager. She will be the main link between our VHTs and LfM’s partners in Uganda, as well as LfM’s Uganda liaison when I return to New York. Some of her duties will include aiding in the acquisition of mobile phones, ensuring they are loaded with LfM’s software, distributing them to the VHTs, helping in the training and usage of the mHealth technology and handling project logistics before beginning the pilot which will happen upon my return to Uganda in three weeks time.

Program Manager, Winifred

Mid-wife, Immaculate, who co-organized the VHT lunch

Wednesday, March 9th
Wini and I worked out details regarding further screening of the VHTs for Thursday (March 10th), to complete the full complement of VHTs who will be assigned to the 25 respective villages* represented in the pilot project. I informed Mr. William Nabangi we needed at least 3 CHWs from each new village to be screened to complete the number of VHTs needed to execute the pilot. We also scheduled the VHTs’ formal training with the AIDS Information Centre (AIC) and Dr. Olive Sentumbwe-Mugisa from WHO, who will conduct a reproductive health training workshop after AIC completes their 5-day HIV/AIDS training course next week. AIC’s training will begin this Friday, March 11th.

VHT candidates being shown LfM's mobile health technology with Program Manager Winifred

Thursday, March 10th
As we had not completed recruiting all 25 VHTs, I went up to Mwera to do further screening of potential candidates. We ultimately screened 120+ people to fill fifty positions. We successfully screened and selected approximately 10 more teams, giving us a total of 23 VHTs. As we had 46 CHWs (just 4 short of the 50 required), I coordinated with Wini and Immaculate (resident mid-wife) to organize daily lunches that would begin Friday and continue for 6 days.

Friday, March 11th
Trainers came up from the AIDS Information Centre that morning. They divided our VHTs into two groups: one assigned to Community Hall, and the other to outside the maternity clinic of the Health Center IV. While training commenced, I completed the screening of the final VHTs, who were then sent to join the other trainees. All 25 VHTs positions are now filled and the HIV/AIDS and Family Planning training course, which will be followed by WHO’s reproductive health training, is underway. After instruction, we had a group lunch. Before dispersing, everyone was compensated for their transport needs and time.

Hon. Sylvia Ssinabulya introducing 1st day of VHTs' HIV/AIDS training course with AIC

1st day of VHT's HIV/AIDS training with AIC

1st day of VHTs' HIV/AIDS training with AIC

Community Hall, where one of the two group sessions took place

Lunch during Training

Saturday, March 12th
I again traveled to Mwera to ensure the VHTs were all accounted for and still participating in the training (no absentees, etc.). The VHTs were all present and the trainers’ feedback regarding their motivation and adeptness was extremely positive. Wini, our Program Manager, is currently staying in Mwera to oversee the 6 day-training.

Upon my return home later that night, I had further meetings regarding the development of LfM’s mobile health technology software. I met with Dr. Eddie Emukooyo from the Ministry of Health, who was a chief developer of ICT4MPOWER. This conceptual model is extremely similar to the structure of LfM’s project pilot currently being implemented in rural Uganda. He was very supportive of our work and told me he wanted to “harmonize our efforts.” We will be in contact as to how he can assist LfM’s efforts in the future.To learn about the ICT4MPOWER project, click here.

*25 villages: Bananze, Bubangi, Bukundugulu, Bullenge, Bumbugwe, Butayunja, Butegaya, Kafumbirwango, Kakindu Church Zone, Kakindu Malwa, Kakindu Town Council, Katebere , Kireku Bugol, Kitebere, Kiwande, Mawanda Kyengeza, Mwera, Mwera Mukadde, Nabwiri Kaggungu, Namanddwa, Nawanjiri, Ngandwe, Nsambya, Vvumbe

Tuesday, March 1st
In the morning, I met with Hon. Sylvia Ssinabulya at the Ugandan Parliament in Kampala. Subsequently, we went to meet with Rosemary Nabifo Wamimbei, Secretary of the NGO Board, regarding expanding Life for Mothers’ mission into other districts of Uganda.

Rosemary Nabifo Wamimbei, Secretary of the NGO Board

Wednesday, March 2nd
I went to the Health Center IV in the Parish of Mwera where we spent the entire day screening 25 VHTs (50 CHWs) and another 4 community health workers. Each individual was assessed for basic competency in the use of the data-registration mobile technology. Prior to the screening, briefing sessions took place amongst all of the teams. Unfortunately, less than a third of the teams were deemed competent and therefore our search continued for additional VHTs.

During this visit, I met with Immaculate, a midwife and friend, at the Health Center IV who showed me a non-functioning blood pressure machine – non-functioning due to the unavailability of batteries. This is an unfortunate example of how weak infrastructure and supply shortages negatively impact the resident population’s access to health services.

Midwife Immaculate showing me defunct blood pressure machine

Thursday, March 3rd
Regarding the search for a new Program Manager, I met with the supervisor of Winfred Namireme, a potential candidate, who works for the African Health Education Initiative, a join collaboration between Johns Hopkins University and Makerere University. We discussed her work history, etc. I was impressed with her past work performance and therefore I suggested she come on Sunday to screen for the additional VHTs who could acquire basic competency skills to use our  mobile health technology.

Friday, March 4th
As mentioned in previous entries, LfM wants to secure the support of the Village Chairpersons of the initial 25 villages working as part of our pilot project. On Friday, I was able to meet with twelve of them (all men). After introducing them to Life for Mothers’ pilot project and mission, I gave out our Life for Mothers pins. If you look closely you can see the Village Chairpersons wearing them.

Village Chairpersons being introduced to the pilot project

Village Chairpersons wearing LfM pins

Saturday, March 5th
On Saturday, I was a guest on Radio One’s Health Net show (9am-10am) and was interviewed by Dr. Henry Ddungu, from Makerere University. The interview involved questions regarding the specific pilot project in Busujju county as well as the substantive issues regarding maternal/neonatal mortality in Uganda.

Dr. Harry being interviewed on health talk show, Health Net on Radio One

Dr. Harry being interviewed by Dr. Ddungu on Health Net, Radio One

Sunday, March 6th
Winfred Namirembe and I travelled to Mityana to screen additional VHTs in order to complete the full complement of 25 VHTs in the basic use of mobile health technology. After witnessing her work during the entire day with the VHTs, we finalized our decision to hire Winfred Namirembe as our new pilot project Program Manager. She has accepted to be the Program Manager for the pilot project in Busujju county for Life for Mothers.

Winifred demonstrating how to use LfM's mobile health technology

The VHTs who were screened

I spoke with Hon. Sylvia Ssinabulya regarding the role of William Nabangi, Clinical Officer and Coordinator of the Village Health Teams (VHTs) in the recruitment of additional community health workers (CHWs) to complete the necessary number of VHTs. This will require an additional six men, ultimately resulting in a more balanced gender ratio of 22 men to 28 women (forming 25 VHTs). Additionally, I asked Hon. Sylvia Ssinabulya to confirm through William Nabangi that the recruited CHWs are all able, at the very least, to send an SMS text message to one another. Though at a later date they would be additionally screened, sending an SMS is a minimum requirement to be considered for training in the use of mobile health (mHealth) technology.

View of Kampala

Later that afternoon, I had a meeting with Herbert Zake, Head of Corporate Affairs at Standard Chartered Bank, regarding potential sponsorship with Life for Mothers (LfM.) I explained the scope and nature of the pilot project and also gave him the informational DVD. Mr. Zake recommended a meeting with Annie Katuregye and Deus Turyatemba at 5pm, that day, regarding a potential alliance. At the meeting with Annie and Deus I listened to the extremely emotional story of her life. She is truly an amazing person: she is HIV-positive and her husband died of AIDS 20 years ago. She is also the mother of 3 HIV-negative children. She does extensive community work to sensitize people to the realities of those living with HIV/AIDS. She also works to combat stigma, discrimination and denial and urges women and men to get tested so, if they test positive, they can be treated as soon as possible. During her talks she frequently mentioned “HIV is not a death sentence,” a sentiment that I endorse. I introduced her to LfM’s pilot project and we are pursuing options as to whether the bank will support her efforts in working with LfM.

If you would like to read her story, click here: (link to follow)

Tuesday, February 22nd

Tuesday morning, I met with Dr. Francis Runumi, the Commissioner for Health Planning of the Ministry of Health. I gave him the letter he had requested the previous week regarding increasing drugs, supplies and equipment to Mwera Health Center IV (HC). The reason for this increase is that the pilot project would trigger increased demand for medical supplies beginning March 1st. He requested additional information regarding the project proposal and its budget.

Later that morning, I had a two-hour meeting at MTN’s headquarters in Kampala. This was my initial meeting with the person responsible for MTN’s Corporate Social Responsibility (CSR), Ms. Rukh-Shana Namuyimba. I briefed her regarding the nature and scope of the pilot project and also showed her the informational DVD which we began to watch together when the MTN CEO, Mr. Themba Khumalo, came and greeted us. Firstly, he assured us that he is completely behind the project in principal, however he expressed concerns regarding potential interaction between our software applications and their phones. Therefore he asked Brian Kataka (our software designer) and myself to meet with MTN’s IT people. After he left, I continued to talk to Ms. Namuyimba regarding our project. Subsequently, a meeting was tentatively scheduled for Thursday, the 24th, for 10:30 am because Wednesday was a public holiday (mayoral races would be happening throughout the country, including in Kampala). She promised to confirm the meeting that afternoon or Thursday morning.

In the afternoon, I met with the newly re-elected Hon. Sylvia Ssinabulya, who assured me (now that the elections were over) that she would devote much more time to ensuring the pilot project’s success. She also promised to arrange a meeting with the respective 25 Village Chairpersons as well, again with the assistance of William Nabangi.

After my meeting with Sylvia, I met with Simon Kaggwa whom I met on previous trips to Uganda. Mr. Kaggwa is the host of a daily political show on Radio One, the premier Ugandan radio station. After I briefed him about Life for Mothers, he was very moved by the project and its significance, and recommended I meet Jaime Byarunhanga, the host of a weekly health show called Health Net, which airs Saturdays on Radio One. He set up a meeting for the two of us in order to discuss the possibility of my appearance on Mr. Byarunhanga’s show.

Wednesday, February 23rd

Despite the public holiday (mayoral races throughout the country), I was able to do some work, including interviewing Benjamin Byarugaba for the position of Program Manager. I then met with Dr. Hugh Cameron, Visiting Professor, Networks and Software Innovations, at Makerere University, regarding the software development and the timeline of the project. That same day, I also met with Brian Kitaka, the software designer who works with Dr. Cameron. Brian demonstrated the software prototype that will be used to screen CHWs for their mobile phone competency. He was also able to upload the prototype software onto my Motorola phone and I was able to access the form on my own.

Finally, I connected with Ms. Namuyimba who told me that since it was a public holiday she could not confirm the meeting and that she’d do so the following morning.

Thursday, February 24th

Thursday morning Ms. Rukh-Shana confirmed the meeting would take place at MTN headquarters at 10:30 am. Brian Tataka and myself arrived there and I gave a presentation regarding LfM’s pilot project and its specific requirements regarding the telecom aspect of the project. Brian described how the software application would be used and the IT people requested specifications for the server and the phone sets. We promised to supply them later that afternoon. I sent them to Rukh-Shana and she was able to confirm receipt later that day. However, she stated she was required to brief Mr. Khumalo regarding the pilot project, but since he was out of the country she would have to wait for his return.

Friday, February 25th

I had a 7 am meeting with Dr. Olive Sentumbwe-Mugisa, Family Health and Population Advisor from World Health Organization (WHO) Uganda, whom I met numerous times in the past. I informed her of the status of the pilot project and also gave her the informational DVD. She stated she would be able to conduct a 2-day workshop on maternal/reproductive health with the VHTs and Health Staff at the HC IV in Mwera. I also mentioned our need to recruit a Medical Officer and a midwife; Dr. Olive said she would assist in their recruitment.

Late in the afternoon, I had an extensive meeting with Jaime Byarunhanga, Managing Director of Mystic Multimedia and the host of Health Net on Radio One. We went through the informational DVD and the objectives of the pilot project. He agreed to host me on the next show on Saturday, March 5th, in advance of national and global events surrounding International Women’s Day on March 8th.

Today, Saturday, February 26th

I went over to Mulago Hospital (have not visited in a year or two) and had my blood pressure checked. It was normal!

In the morning, I drove up from Kampala again to the Mwera Health Center IV. I met with Honorable Sylvia Ssinabulya (the female Parliamentarian from Mityana and, also, an LfM Board Member). She took time out of her campaign schedule to meet with me and I briefed her on the Life for Mother’s pilot project to reduce maternal/neonatal mortality. I explained its holistic properties and the time frame of the project as well. I also gave her the informational DVD that is currently being televised in the US through February 2011. We scheduled another meeting for February 21^st, after the Presidential & Parliamentary elections.

Later the same morning, we held an orientation meeting for the recruited 25 Village Health Teams. Each VHT comprises two Community Health Workers (CHWs) per team. Mr. William Nabangi mobilized these teams over the weekend. He mobilized 44 CHWs, divided into 28 women and 16 men. He was only able to get 44 CHWs due to the short period of time. We told him he needed to recruit an additional 6 men to complete the recruitment of the 50 CHWs. The orientation meeting lasted over 3 hours where I emphasized the importance of the CHWs’ role in making the project succeed. I explained the holistic strategy we were employing as well as the use of mobile health technology. In addition, I made the following points:

1. The pilot project would take between 4 and 6 weeks.
2. The goal of the project was to register as many households during this 4-to-6 week period as possible, as well as increase the number of antenatal visits and births that take place at the Health Center IV. I made them aware of the fact that 40% of all the deaths of children under the age of 5 take place in the 1^st month of life; therefore it was necessary for the VHTs tand HC lV to closely monitor newborns during this critical time period.
3. All VHTs will be given comprehensive intervention training in the following areas: family planning, HIV/AIDS, maternal/reproductive health, & child survival.
4. Each team will be given, and trained to use, mobile phones to register all households in their respective villages. Initially, after the software applications have been placed on these mobile phones, the VHTs will be subjected to a simulated session where each VHT will act as an interviewer and the other as patient. During this time, the IT director will determine which teams can be trained in the usage of these phones; he will be assisted by a Peace Corps Volunteer who is stationed at the Health Center IV. The teams unable to be trained to use the phones will be replaced with new recruitments. Those teams will go through the same process. Once we are reasonably confident that they can be trained in the usage of the phones, they will receive the educational training previously mentioned.

After returning to Kampala, I met with the Commissioner of Health Services Planning, Dr. Francis Runumi, at the Ministry of Health and gave him the informational DVD. The meeting was extremely positive; I re-introduced him to the pilot project and he recognized the significant impact the project could have on Uganda’s health care system. Earlier at the HC lV, during the Q&A with the VHTs, I was asked what Life for Mothers would do to address the gaps in human resources, drugs, equipments, and supplies that women of reproductive age encounter when they come to the HC IV. I communicated the VHTs’ concerns, and Dr. Runumi asked me to return to Mityana and meet with the District Health Officer, Dr. Francis Kigongo. He told me I should ask Dr. Kigongo to write a special request for additional drugs, supplies, equipment because of the increased demand that would be generated by the implementation of the pilot project study. After receiving this letter, Dr. Runumi would request these additional provisions from the National Medical Stores.

Tuesday, February 15^th, 2011

I visited the AIDS Information Centre (AIC) to discuss LfM’s pilot project with Dr. Raymond Byaruhanga. Unfortunately Dr. Raymond Byaruhanga was not available and I met with two of his trainers. Since 1993, the AIC has been providing family planning services in addition to comprehensive AIDS/HIV counseling, testing, and treatment. Regarding Family Planning services, we discussed long-acting and permanent method procedures (LAPM.) These included the following: IUDs, the placement of Norplant, inject-able hormones, tubal ligations, and vasectomies. Dr. Proscovia Namuwenge (one of the trainers) and I agreed that she would be able to train the clinical officers and/or nurses in the placement of Norplant procedures.

After arriving back in Kampala, I met with Dr. Hugh Cameron (PhD), Visiting Professor and Department Head of Innovations of Software Development, Faculty of Computing and Information Technology of Makerere University. I introduced him to Life for Mothers, explained the pilot project, and gave him our informational DVD. We discussed the utilization of mobile phone applications to collect health data and register all households in the field. Dr. Cameron recommended that LfM create a very user-friendly prototype for the initial mobile phone data collection. He further recommended that we work with the VHTs with this prototype to determine their capability to be trained in the usage of this technology. LfM will be working very closely with Dr. Cameron’s team to design questionnaires to be used as the prototype. Once developed, the software would be uploaded onto the phones, and we would meet with the VHTS to go through a trial period to determine who was capable of being trained in this technology.

Wednesday, February 16^th, 2011

I drove up to meet with the District Health Officer of Mityana, Dr. Francis Kigongo, and discussed the prior conversations that I’d had with Dr. Runumi the previous day. I also met with Dr. Robert Balikudembe (the Medical Officer assigned to the Health Center IV in Mwera.) We worked on drafting the letter to the Permanent Secretary of the Ministry of Health requesting the additional supplies due to the pilot project study.

After I returned to Kampala, I had another meeting with Dr. Cameron to further discuss the development of the questions to be used on the mobile phones. He introduced me to his team and related to me that they would be working on a daily basis, throughout the Presidential election period.