Impact of a surgical sponsorship program on compliance with decision-to-delivery intervals in rural hospitals in Uganda

Abstract

Background: An emergency caesarean section is a critical intervention to reduce maternal and fetal risks during labour complications. The decision-to-delivery interval, recommended internationally of seventy-five minutes or less, is a key indicator of quality in emergency obstetric care. In rural western Uganda, this interval is often prolonged due to financial and infrastructural barriers. This study evaluated the impact of a sponsorship program’s case management and documentation procedures on compliance with the decision-to-delivery interval in a rural hospital setting. Methods: A retrospective cross-sectional study was conducted from January 2020 to December 2023 across four comprehensive emergency obstetric care hospitals in southwestern Uganda: Ibanda, Nyakibale, Rushoroza, and Rwibaale. Data were extracted for all emergency caesarean section cases with indications in categories one and two. Documentation rates and compliance with the decision-to-delivery interval (defined as less than seventy-five minutes) were analyzed using descriptive statistics, trends, and stratified graphs. The study sample compared data from non-sponsored and sponsored patients covered by a financing program offered by African Mission Healthcare, a not-for-profit organization working in Africa. Results: Surgical Access for Everyone–sponsored patients consistently demonstrated higher documentation rates for the decision-to-delivery interval (70–80%) compared to non-sponsored patients, especially from 2021 onwards. By the fourth quarter of 2023, documentation in both groups exceeded 75%. All facilities showed a reduction in the median decision-to-delivery interval over time, with Rushoroza and Rwibaale achieving the most significant declines to below 60 min by 2023. Compliance with the decision-to-delivery interval of less than 75 min improved from 30% in 2020 to nearly 70% in 2023. Facility-specific trends revealed overall improvement, with Rushoroza and Rwibaale showing the most significant progress by 2023, while Ibanda exhibited the slowest progress. Conclusion: The Surgical Access for Everyone sponsorship program and its required case management and documentation procedures enhanced compliance with the decision-to-delivery interval in emergency obstetric care, demonstrating benefits for both sponsored and non-sponsored patients. Sustained improvements highlight the importance of structured funding and oversight. To maintain and expand these gains, targeted facility-level interventions, strengthened data systems, and continued investment in clinical training are recommended.