The Obulamu Mama framework: development of an evidence-informed implementation framework for community obstetric referral systems in rural Uganda
6 affiliations
- 1School of Global Public Health, New York University, New York, NY, USA
- 2Department of Emergency Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
- 3Faculty of Humanities and Social Sciences, Mountains of the Moon University, Fort Portal City, Uganda
- 4Trinity Medical Sciences University, Warner Robins, GA, USA
- 5Department of Psychology, University of Minnesota Twin Cities, Minneapolis, MN, USA
- 6Life Sciences, University of Nevada, Las Vegas, NV, USA
Abstract
Background: Preventable maternal deaths remain disproportionately concentrated in low- and lower-middle-income countries. In rural Uganda, delayed recognition of obstetric emergencies, transportation barriers, fragmented referral pathways, and inconsistent communication continue to limit timely access to emergency obstetric care.
Objective: To develop an evidence-informed implementation framework for strengthening community obstetric referral systems in rural Uganda.
Methods: We conducted a framework development study using a structured, iterative five-phase process informed by maternal and newborn health evidence, implementation science, systems thinking, international health-system guidance, and Ugandan health policy. Evidence was identified through purposive, targeted searches of PubMed, World Health Organization resources, and Uganda Ministry of Health policy and guidance repositories. Development included problem identification, identification of evidence-informed implementation strategies, preliminary framework development, contextual refinement through in-country review by a Ugandan academic collaborator, and final framework integration.
Results: The Obulamu Mama Framework comprises six interdependent implementation domains: community workforce strengthening; standardized community midwifery resources; closed-loop digital referral communication; coordinated referral networks; continuous quality improvement and supportive supervision; and monitoring, evaluation, and adaptive learning. The domains are designed as complementary components of an integrated maternal referral system aligned with existing community and district health structures.
Conclusions: The framework translates existing evidence and health-systems principles into an implementation roadmap for community obstetric referral systems in rural Uganda. It provides a foundation for feasibility testing, implementation research, and prospective evaluation and may inform adaptation of referral-system strengthening approaches in other resource-constrained settings.
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BibTeX
@article{whitley2026obulamu,
title = {{The Obulamu Mama framework: development of an evidence-informed implementation framework for community obstetric referral systems in rural Uganda}},
author = {Krista Whitley and Emmanuel Twesige and Andre Craig Christie and Kai Davide Castellarin and Kidus Yohannes and Daniel de Leon and Nada Dualeh and Sellena Chen},
journal = {Global Health Action},
year = {2026},
month = oct,
doi = {10.1080/16549716.2026.2749302},
url = {https://doi.org/10.1080/16549716.2026.2749302},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The Obulamu Mama framework: development of an evidence-informed implementation framework for community obstetric referral systems in rural Uganda
AU - Krista Whitley
AU - Emmanuel Twesige
AU - Andre Craig Christie
AU - Kai Davide Castellarin
AU - Kidus Yohannes
AU - Daniel de Leon
AU - Nada Dualeh
AU - Sellena Chen
PY - 2026
DA - 2026/10/27
JO - Global Health Action
DO - 10.1080/16549716.2026.2749302
UR - https://doi.org/10.1080/16549716.2026.2749302
AB - Background: Preventable maternal deaths remain disproportionately concentrated in low- and lower-middle-income countries. In rural Uganda, delayed recognition of obstetric emergencies, transportation barriers, fragmented referral pathways, and inconsistent communication continue to limit timely access to emergency obstetric care. Objective: To develop an evidence-informed implementation framework for strengthening community obstetric referral systems in rural Uganda. Methods: We conducted a framework development study using a structured, iterative five-phase process informed by maternal and newborn health evidence, implementation science, systems thinking, international health-system guidance, and Ugandan health policy. Evidence was identified through purposive, targeted searches of PubMed, World Health Organization resources, and Uganda Ministry of Health policy and guidance repositories. Development included problem identification, identification of evidence-informed implementation strategies, preliminary framework development, contextual refinement through in-country review by a Ugandan academic collaborator, and final framework integration. Results: The Obulamu Mama Framework comprises six interdependent implementation domains: community workforce strengthening; standardized community midwifery resources; closed-loop digital referral communication; coordinated referral networks; continuous quality improvement and supportive supervision; and monitoring, evaluation, and adaptive learning. The domains are designed as complementary components of an integrated maternal referral system aligned with existing community and district health structures. Conclusions: The framework translates existing evidence and health-systems principles into an implementation roadmap for community obstetric referral systems in rural Uganda. It provides a foundation for feasibility testing, implementation research, and prospective evaluation and may inform adaptation of referral-system strengthening approaches in other resource-constrained settings.
SN - 1654-9716
SN - 1654-9880
ER -