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Objectives: To assess midwives’ competencies in the application of the manoeuvers for a vaginal frank breech delivery and identify factors associated with midwives’ competency in delivering a vaginal frank breech. Methods: A cross-sectional study was conducted among 143 practicing midwives who were recruited consecutively. A 30-item checklist was used to assess the midwives’ competence in the application of Pinard, Loveset’s, and Mauriceau Smellie Viet manoeuvers. A self-administered questionnaire was used to obtain the associated factors. Descriptive statistics were used to analyze midwives’ competence. Crude Odds Ratios and their 95% confidence intervals measured the association. Results: 87.4% of midwives knew and mentioned a manoeuvre. Slightly half of 72(50.4%) study participants, with a mean score of 12.3 (SD: 2.7), were competent. Competence scores for Pinard, Loveset’s, and Mauriceau Smelie Viet manoeuvres were 69.2%, 44.1%, and 30.8% respectively. Midwives who could mention any manoeuvre were 11 times more likely to be competent (Adjusted odds ratio [AOR]: 11.79, 95% CI: 2.23-58.35, P: 0.002). Midwives who felt confident were 5 times more likely to be competent (AOR: 5.95, 95% CI: 1. 23-28.80, P: 0.026). Conclusion: Overall midwives’ competence was average. The majority were competent with the application of Pinard manoeuvre. Lovset and Mauricea Smelie Viet had below-average scores. The significantly associated factors were being able to mention any type of the manoeuvres, and reporting a feeling of confidence. These findings highlight the need for in-service vaginal breech births training, and a hands-on vaginal breech births practice to improve competence. Recommendations: The health care system should standardize the quality of midwifery practice as stated by the global standard of midwifery practice. Standard guidelines and standard operating procedures should be developed to guide the care practices in health units.

Abstract Background Partnerships and networking are important for an institution of higher learning like Makerere University College of Health Sciences (MakCHS) to be competitive and sustainable. Methods A stakeholder and sustainability analysis of 25 key informant interviews was conducted among past, current and potential stakeholders of MakCHS to obtain their perspectives and contributions to sustainability of the College in its role to improve health outcomes. Results The College has multiple internal and external stakeholders. Stakeholders from Uganda wanted the College to use its enormous academic capacity to fulfil its vision, take initiative, and be innovative in conducting more research and training relevant to the country’s health needs. Many stakeholders felt that the initiative for collaboration currently came more from the stakeholders than the College. External stakeholders felt that MakCHS was insufficiently marketing itself and not directly engaging the private sector or Parliament. Stakeholders also identified the opportunity for MakCHS to embrace information technology in research, learning and training, and many also wanted MakCHS to start leadership and management training programmes in health systems. The need for MakCHS to be more vigorous in training to enhance professionalism and ethical conduct was also identified. Discussion As a constituent of a public university, MakCHS has relied on public funding, which has been inadequate to fulfill its mission. Broader networking, marketing to mobilize resources, and providing strong leadership and management support to inspire confidence among its current and potential stakeholders will be essential to MakCHS’ further growth. MakCHS’ relevance is hinged on generating research knowledge for solving the country’s contemporary health problems and starting relevant programs and embracing technologies. It should share new knowledge widely through publications and other forms of dissemination. Whether institutional leadership is best in the hands of academicians or professional managers is a debatable matter. Conclusions This study points towards the need for MakCHS and other African public universities to build a broad network of partnerships to strengthen their operations, relevance, and sustainability. Conducting stakeholder and sustainability analyses are instructive toward this end, and have provided information and perspectives on how to make long-range informed choices for success.