Introduction A global shortage of health workers has led many countries to train community health workers (CHWs) to promote and educate local community members. Through their training, maternal health can be improved by increasing the number of women accessing services such as antenatal care and delivering under the assistance of a skilled birth attendant. Uganda is one country which has trained community health workers and Mbale CAP/PONT, a health links programme between Rhondda Cynon Taf in South Wales and three districts in Eastern Uganda has assisted in the training of them in village health teams (VHT). Mable CAP/PONT has trained several types of CHWs and has introduced motorbike ambulances to improve access to maternal care. Transport to Hospital In 2010, Mbale CAP/PONT introduced motorbike ambulances to the districts of Mbale, Manafwa and Bududa which are able to travel on rough and hard terrain to collect women in labour who would not otherwise be able to reach a health facility. Motorbike ambulances operate from rural health centres. The willingness of the CHWs to serve in their communities has contributed to the success of the VHTs and made them a highly valued resource. They provide health information and advice, as well as enabling access to hospitals in emergencies through the motorbike ambulance service. A total number of 16,813 journeys have been made in the three districts since the introduction of the motorbike ambulances in 2010 many of which resulted in life-saving journeys and Figure 2 illustrates this. Sustainability Maintenance and cost of fuel was identified as a barrier to the use of motorbike ambulances. During FGDs and SSIs, participants were asked if they had ideas on how to sustain the motorbike ambulances, to which several suggestions were made. These included forming groups of people who could engage in income generating activities (IGA). The money made from IGA would be distributed to village members in the form of loans with a small amount of interest which could contribute towards the motorbike ambulances. Mbale District had started to sustain projects through asking for small monthly contributions from community members. Anna Wiltshire How has the Training of Community Health Workers Impacted Behaviour Change on Maternal Health Issues in Three Rural Districts in Uganda? The Importance of the Link between the Community and the Health Facility The linking of VHTs with the rural health centres enabled community members to benefit from local services. The VHT was described as a “bridge” between the two. Several mothers explained the benefit of the Traditional Birth Referral Attendant (TBRA) travelling with them to the health centre enabling a smooth referral and establishment of trust. Motorbike ambulance drivers were able to see the health needs of communities as they worked. Following their advice, trained health workers were able to travel into villages and deliver specific health education messages. Vaccination uptake increased in the three districs due to improved education through the VHT. A health professional in Manafwa stated that lying down in the motorbike ambulance had become “associated with dead bodies, so people fear it”. These comments relate back to the need for greater sensitisation in communities to enable acceptance and reduce fear which is often experienced due to a lack of understanding and education. Results Traditional Beliefs Many women stated that their health beliefs had changed from practicing traditional medicine and witchcraft due to the education received from members of the VHT. They explained how they would now attend the health facility which had, in some cases saved their lives. A health professional explained how the reduction in traditional beliefs had resulted in a reduction in infant sepsis. This was often caused by “bad practices around the cord” causing tetanus such as cutting the cord with an unclean instrument and putting ash or cow waste on the cord. She explained that increased education from the VHT to the community and Mbale CAP/PONT’s provision of motorbike ambulances had resulted in an improvement in maternal and infant health. Although some women continued to practice traditional medicine in the community, there remained a level of appreciation and respect towards the work of the VHTs. Motorbike Ambulances and Modes of Transport to Health Facilities Community members referred to the motorbike ambulances with great pride as they had saved hundreds of lives locally. Communication between the VHT and the motorbike ambulance driver was noted as integral for the system to work. Improved transport and increased understanding of the importance of health facilities through community sensitisation provided by the VHT, resulted in women seeking health care and reducing the delay in receiving adequate care. During the rainy season, CHWs carried women in labour using different forms of transport. This was often the case in Bududa, where the terrain is torturous and where regular landslides occur. Motorbike ambulance drivers were able to assess an obstetric emergency and call the health facility to warn of their imminent arrival and to encourage theatre preparation if required. Positive comments were made that expectant mothers were able to lie down comfortably as well as negative comments that it was akin to being dead. Some felt that by traveling on the motorbike ambulance they would be operated on upon arrival at the health centre, regardless of their need. Conclusion Through the education provided by CHWs, women in the communities expressed a new acceptance towards - attending services such as antenatal care, - giving birth in the presence of a skilled birth attendant, - uptake of vaccinations and - rejection of traditional medicine. A change in behaviour was believed to have occurred due to: - education provided by the CHWs - motorbike ambulances which likely increased VHT effectiveness, There is a need for further exploration and data collection to improve the evidence and knowledge gained during this project. Figure 1: Motorbike Ambulance Figure 3: Members of the Village Health Team Figure 4: Ugandan Road Figure 5: Postnatal Clinic Aim The study investigated whether training CHWs in three districts in Uganda led to an increased knowledge, understanding and use of maternal health services. It also evaluated the use of the motorbike ambulance. Method The evaluation took place in April Three focus group discussions were conducted with groups of CHWs using pre-prepared open questions. Semi-structured interviews were conducted with seventeen beneficiaries across the three districts who were predominantly women who had benefitted from the motorbike ambulances. Figure 5: Beneficiaries that were interviewed in Manafwa