Jacqueline Cutts

Iganga District, East Central Region, Uganda

More than 190,000 children under 5 die every year in Uganda, and the East Central Region has a 20% higher under-5 mortality rate (106 deaths/1,000 live births) than the national average (90 deaths/1,000 live births). The leading direct causes of under-5 mortality include neonatal conditions (prematurity, birth asphyxia, and infection), malaria, diarrhea, pneumonia, and both maternal and child malnutrition. While evidence-based interventions already exist for all of these conditions, the issue is really why these interventions aren’t more widely utilized. Many of these root causes can be understood through an extended application of the Three Delays Model, through which we posit that both maternal and under-5 deaths stem from: (1) A delay in recognizing the need to seek care, and making the decision to seek care, (2) A delay in physically accessing a healthcare facility, and (3) A delay in receiving high-quality care once in a health facility.

Safe Mothers, Safe Babies (SAFE) seeks to understand and address the leading direct causes of under-5 mortality by extending the Three Delays Model, traditionally used to understand maternal mortality to the first 1,000 days of life (conception to a child’s 2nd birthday). The Three Delays refers to a model that has been widely utilized to understand maternal mortality in many countries and contexts across the world. Understanding this utility is important to evaluating its applicability to early childhood mortality. The intervention package includes:

1. Working with community groups to improve knowledge and practice of healthy behaviors in the first 1,000 days, with emphasis placed on utilizing both preventive and curative healthcare services.
-Ten community groups will be trained in maternal and child health with our already proven curriculum, and then promote good maternal and early childhood health behaviors in their communities through collaboratively-designed community outreach and home-to-home visitation programs.

2. Utilizing a motorcycle ambulance and family savings project to increase physical and financial access to a healthcare facility.
-Rides will be highly subsidized at a cost of 3,000 shillings ($1.15US) to pregnant and post-partum women and children under age 5.

3. Improving the supplies, technology, and medical training of healthcare providers to facilitate the provision of high-quality care during the first 1,000 days.
-These improvements will include: provide a package of very basic medications and supplies that are essential to child health in the first 1,000 days; providing training to all healthcare workers in the facility; and making a few key improvements to the physical structure of the health facility.

Jacquie is SAFE’s Founding President and CEO. An honors graduate of both Vassar College (BA in Political Science) and Emory University Rollins School of Public Health (MPH in Global Health and Certificate in Maternal and Child Health), Jacquie’s greatest passions are the sustainable improvement of maternal and child health in empowering ways that marry community participation with scientific evidence of what works. As a wife and mother of three great kids, maternal and child health are always on her mind. Jacquie is a social innovator and problem-solver, a fierce advocate for women’s rights and health, and a dedicated mentor to aspiring public health leaders.

Safe Mothers, Safe Babies (SAFE) is a nonprofit organization that works to improve maternal and child health (MCH) and survival in Uganda through community-based and facility-based approaches targeting the Three Delays. SAFE Three Delays projects include: (1) improving MCH care-seeking and preventive behaviors through participatory educational outreach with community groups; (2) improving access to health centers and hospitals through motorcycle ambulances and personal savings programs; and (3) using innovative technology and medical supplies to improve quality of care through strengthening facility infrastructure, commodities, and medical training. SAFE has been working in the East-Central region of Uganda for 7 years.