Digital Public Defence: Susan Munabi-Babigumira

MSc Susan Munabi-Babigumira at Institute of Health and Society will be defending the thesis Quality of maternity services in low- and middle-income countries: analysis of health system bottlenecks and strategies for improvement for the degree of PhD (Philosophiae Doctor).

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Photo: Ronnie Babigumira

The public defence will be held as a video conference over Zoom.

The defence will follow regular procedure as far as possible, hence it will be open to the public and the audience can ask ex auditorio questions when invited to do so.

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Digital Trial Lecture - time and place

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Adjudication committee

  • First opponent: Associate Professor Salla Atkins, Tampere University, Finland 
  • Second opponent: Professor Göran Tomson, Karolinska Institutet, Stockholm, Sweden 
  • Third member and chair of the evaluation committee: Associate Professor Heidi Fjeld,  Institute of Health and Society, University of Oslo 

Chair of defence

Associate Professor Odd Martin Vallersnes, Institute of Health and Society, University of Oslo

Principal Supervisor

Research director Atle Fretheim, Norwegian Institute of Public Health, Oslo


Strong health systems are essential to ensure good quality maternal health care. However, health systems in several low- and middle-income countries often struggle to provide good quality care, leading to high death rates among mothers and babies. This thesis examines the factors that influence the quality of maternity services in low- and middle-income countries. The thesis uses Uganda as a case to further examine these factors and to explore mothers’ and health workers’ experiences of care. 

Through a synthesis of qualitative studies, the thesis identified several reasons why good quality maternity services are difficult to provide in many low and middle-income countries. These reasons included a lack of health workers, as well as poor training of the health workers that were there, a lack of medicines and other supplies, and poor physical infrastructure. 

Policy makers and managers in the Ugandan study described the strategies that they used to try and address these types of problems and improve the quality of maternity care. These included increased training in midwifery, improved distribution of medicines and supplies, purchase of ambulances, and the construction of maternity wards. However, the capacity of health facilities to provide good quality services remained a challenge. Health workers in Uganda reported that an increase in the tasks they were expected to deliver and the number of people they served further stretched their limited resources. Health workers sometimes improvised and used their own resources in an attempt to improve the situation, but this led to more demands on their time and resources. In addition, mothers were expected to buy their own supplies, which led some mothers who could not afford this to deliver at home.
Improving maternity services in low-and middle-income countries will require that countries address the barriers at all levels of their health system that currently hamper the provision and experience of good quality care.  

Additional information

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Published Oct. 13, 2020 2:49 PM - Last modified Oct. 28, 2020 9:19 AM