Knowledge For Change

Ethical & Sustainable Development Projects in East Africa

Home / Projects & Research / Respectful Maternal Care

Respectful Maternal Care

Summary

Uganda has one of the highest maternal mortality rates in the world. The Sustainable Development Goals framework focuses on improving Maternal Health through gender equality, human rights, empowerment and poverty reduction. Disrespectful care not only undermines women’s human rights and disempowers them; it also results in poor levels of engagement with public services and damaging delays in accessing them. 99% of all maternal mortality occurs in Low- and Middle-Income Countries; much of this is due to delays in women seeking care. In Uganda, it is not uncommon for women to receive verbal or sometimes physical abuse whilst giving birth in health facilities. Through empowerment of women and collaboration between healthcare staff, stakeholders, families and communities, this project aimed to improve the well-being of mothers and babies.

Links to our Wider K4C Activities

K4C's work on Respectful Maternal Care K4C has been longstanding and ongoing, with the teams in Uganda, Tanzania and UK collaborating to provide bedside mentorship and role-modelling of: communication, compassion, privacy, dignity, confidentiality and patient-centred care. Our focus on user-engagement keeps the voices of the patients heard and central to our programme planning and evaluation. K4C staff have continued to facilitate education and training, capacity-building efforts and targeted interventions improving how healthcare is administered to women, mothers and children. This work is continuous, and is promoted throughout all of our programme work. and has its origins in the funded WeCare: Respecful Care Project.

We continue to see very tangible outcomes of increased patient attendance in the facilities where we work, and our evaluation work and interviews with patients highlight how important receiving respectful care has been in their decisions to seek care. Kagote Health Centre in Fort Portal continues to have a thriving birth rate following partnership with K4C, having had many years without any births at all. In 2023, following the establishment of the Ninsimma Centre for Rehabilitation of People with Disabilities at Fort Portal Regional Referral Hospital, patient numbers increased more than 12 times that of the previous year.

K4C is proud that its work benefits the health systems in Uganda and Tanzania, but also that it brings benefits back to the UK NHS workforce. Students and volunteers report that working with us helps them understand the different ways respect is understood and demonstrated in different cultures, a cultural competence that they take back into caring for their diverse patient cohort in the UK. We also deliver lectures to the University of Salford nursing students on the lessons that we have learnt about how respectful care saves lives in every setting.

 

 

 

 

WeCare: Respectful Care Project

Objectives

The ‘WeCare’ research project was initially funded by Wellbeing of Women in partnership with the Royal College of Midwives and the Burdett Trust for Nursing (Award Ref IFA203, £20,000) and ran throughout 2017 and 2018. It involved close collaboration between K4C’s professional midwifery volunteers and our midwifery colleagues at Kagote Health Centre, Uganda. Interviews and focus groups were conducted with midwifery staff and mothers to assess their perceptions of ‘respectful care’ and the barriers faced in delivering such care. For example; mothers expected privacy whilst giving birth, however midwives were often unable to provide this due to a lack of privacy screens. Midwives also explained how they were unable to give the mothers as much time as they would like due to being very overworked, under resourced and often having multiple critically ill mothers to assist simultaneously. At times, they may be forced to be slightly rude or abrupt with one mother in order to move on and provide better care for the next.

Gaining a detailed understanding of the challenges faced by mothers and staff enabled us to carefully plan our interventions to maximise their impact and sustainability. Our volunteers were able to suggest simple positive changes to practice that would not put additional pressure on staff. For example, staff were urged to greet mothers respectfully and introduce themselves by name; this small change was gratefully received by mothers. Other interventions included providing basic new equipment such as privacy screens and curtains, delivery beds and new mattresses for the ward beds. We renovated the maternity unit and waiting areas and built new facilities for cooking, toilet and hand washing. Our volunteers also provided training in aspects of respectful care, including allowing mothers their choice of birthing position, providing more information about procedures before beginning them and providing counselling and grieving care.

Project Leads

 

                                   Mrs  Euphrasia Kabahuma,  Kagote  Health  Centre  III

 

 

 

 

 

Ms Hannah Webster, Global Health Professional Volunteer

                                                                                                          Ms Barba Kamara, Mountains of the Moon University

Expansion of Respectful Care Project, Research & Knowledge to Zanzibar

K4C is always encouraging our staff, volunteers, and students to share their learning and ideas on Respectful Care across K4C location sites, from Fort Portal and Kampala in Uganda, to Zanzibar and Moshi in Tanzania, as well as with local healthcare staff working in the facilities.

Recently in Zanzibar, K4C had UK Midwife, Chanelle Beaumont, stationed in Jitimai District Hospital, Stone Town, for a period of 6 months. In the Maternity Department, between March - October 2025, Chanelle assisted in hands-on practice, particularly supporting difficult and complicated labour and deliveries, provided post and antenatal care to mothers, and led on the exchange of knowledge and training with local hospital staff. Her own qualifications as an NMC-registered midwife, and having engaged with principles illuminated in the Respectful Care project, positioned her well to be able to showcase to others what safe and respectful midwifery care can, and should, look like in lower-income and lower-resource settings.

Before carrying out any teaching, Chanelle (and the other volunteers) would work to collect data on identifying needs and gaps of knowledge. The aim was to highlight where expertise would be best targeted. Having done this, Chanelle recognised that there was an ongoing need for greater understanding of emergency care amongst post-qualified nurses and midwives. She pulled together preliminary data, quoted a budget according to K4C funds and student donations (kindly donated by a group of student Adult Nurses who had been on placement in the weeks before), and organised five "stations" focused on different aspects of emergency maternity care, to which she allocated different K4C nurse-midwives according to their area of expertise, alongside student midwives on placement at the time. The team then invited staff from both Jitimai and Mnazi Mmoja hospitals to attend an in-person training day on Sunday 17th August 2025, in Jitimai District Hospital.

The exciting training and study day was named and advertised around the hospital as "Jitimai District Hospital Maternity Study Day", and was facilitated by ZED Co. Limited, a healthcare provider on contract under the Zanzibar Ministry of Health. The image below shows the poster circulated by the team!

The training day involved North-South and South-South teaching on the following topics:

  • Breech births
  • Neonatal resuscitation
  • Foetal monitoring
  • Episiotomy
  • Wound care
  • Meconium aspiration
  • Abruptio placentae
  • Post-partum haemorrhage

Twenty-five nurse-midwives attended the day and completed pre- and post-teaching surveys. The team collected the feedback to assess learning outcomes on each of the topics for every station. Chanelle then summarised and analysed the data and wrote up the findings in a coherent report. You can open the final draft of the report below and read about the training outcomes!


Emergency Study Day Report Cover

Click the image above to download and read the full report.

Overall, the training and study day was a great success. You can look through photos below of the team in action. Congratulations Chanelle and the K4C team!

Team in action
Team in action
Team in action
Team in action
Team in action
Team in action
Team in action
Team in action

Mother's Waiting Room, Neonatal Intensive Care Unit Department,

Fort Portal Regional Referral Hospital, Uganda

Background

In late 2025, K4C identified a need for fundraising at Fort Portal Regional Referral Hospital (FPRRH). In cases when their babies are referred to the Neonatal Intensive Care Unit, many mothers were being given accommodation on the grounds of FPRRH while they wait to be discharged by way of a small room hosting six, single, dysfunctional metal-framed beds fitted with worn down mattresses that did not have protective sterile covers fitted to them. When patient numbers increase beyond the room’s capacity, some mothers ended up sleeping on the floor, causing overcrowding and limiting floor space. The main door, like many of the windows, were not fitted with glass, nor mosquito netting, allowing for cold breezes and rain to enter the room, as well as mosquitos and other insects, preventing the mothers from achieving a restful sleep, and increasing the likelihood of malaria transmission. Attached to the bedroom was a wash facility with poorly consolidated wash infrastructure, including a sink, shower pipes and part of a toilet. The door handle was broken, limiting privacy for mothers. With no waste disposal system, the bathroom frequently filled with waste material, increasing the risk of infection. As a result, many mothers walked to other hospital bathrooms to wash themselves, further posing a risk to the health of these postnatal mothers.

K4C decided to begin planning how to refurbish this accommodation, and we created a fundraising plan via our KindLink page: Knowledge for Change fundraising & online donations | KindLink and promoted it on our Instagram:

Our Goal

Our goal was to create a conducive, safe, and supportive environment for mothers caring for preterm babies in FPRRH. With funding, K4C proposed to deep clean the room to ensure it was transformed into a sterile environment. Other objectives were to repaint the walls, purchase and replace the broken beds, mattresses, and Mackintosh sterile covers. Beds that were deemed salvageable were to be repaired, while new mosquito grills were purchased and fitted to the windows, and similarly, clean, new, washable, individual mosquito nets fixed to each of the beds. The bathroom would be disinfected, repainted, and consolidated infrastructurally with a new door handle, shower, and flushing toilet. Additionally, we hoped to cover the outside veranda with a roof, wall and new floor, in order to make space for two new beds, thus increasing accommodation capacity for mothers as they wait for their newborn babies to be discharged from the NICU.

K4C received funds from a variety of sources, students on placement, previous staff and volunteers, and external donors also. The funds were organised and allocated to relevant resources, labour, staff involved in the refurbishment project. We have prepared a written report detailing our goals, the work undertaken, and final reflections on this fundraising project, which you can read by clicking below:

 

 

 

 

Mother's Waiting Room NICU FPRRH Fundraising Report 2026

 

Respectful (Maternity) Care in Uganda

2024 Activities on Respectful Maternal Care

Throughout 2024, we have continued to implement the findings of our original WeCare project across all our partner facilities in Uganda and Tanzania. Our staff and professional volunteers have provided ongoing training and mentoring to support simple changes in practice, for example urging staff to greet mothers respectfully and introduce themselves by name, allowing mothers their choice of birthing position, providing more information about procedures before beginning them and providing counselling and grieving care. Other interventions have included providing basic new equipment such as privacy screens and curtains, delivery beds and ward mattresses and supporting general maintenance of maternity units, including kitchen, toilet and hand washing facilities.

Implementing these simple, cost effective and sustainable interventions has greatly improved the provision of respectful and high-quality care received by mothers and has led to increasing numbers of women seeking care at our partner health facilities. For example, Kagote Health Centre now averages 45 births per month, compared to just 22 prior to our WeCare project.

We’ve also continued to integrate the findings from our original WeCare Project into other areas of care, for example our Neonatal Sepsis Project which includes a training focus on high quality maternity care to reduce infection risks for both mothers and their babies and advocates for improved post-natal health education. Within our Rehabilitation Programme, we’ve worked in partnership with Amputee Self-Help Uganda (ASNU) to improve access to high quality services and reduce disability related stigma for amputees.

Pictured: Tiggy, K4C Global Health Professional Volunteer Midwife following a successful triplet delivery, midway through her 2-year
placement with K4C in Fort Portal (Uganda).

 

Conclusions & Related Publications

A number of simple, cost effective and sustainable interventions were implemented over the course of the project which greatly improved the level of respectful care received by mothers. The numbers of mothers accessing care at Kagote Health Centre continued to increase during and after the project, and the facility was selected as host for the National day of the Midwife celebrations in 2018, in recognition of its reputation and achievements. K4C’s close partnership with Kagote is ongoing and the successes of this project have been implemented at other K4C partner facilities. More information on the project and its findings have been published in the article below, which can be accessed for free:

Ackers, H.L, Webster, H., Mugahi, R. & Namiiro, R. (2018) What price a welcome? Understanding structure agency in the delivery of respectful midwifery care in Uganda. International Journal of Health Governance (Volume 23, Issue 1)

Future Plans

Based on our work so far, we have been responding to the needs in the health facilities in which we work and considering how we can extend respectful care to both unborn and newborn babies, who do not have a voice to tell us what they need. We are developing some new work around neonatal sepsis focused on linking respectful maternity care to respectful neonatal care, to improve outcomes and survival rates for some of the most vulnerable patients we work with.