In Sembabule, getting maternal health services is a nightmare

SEMBABULE. It is noon at Ntuusi Health Centre IV in Sembabule District. The centre serves close to 60,000 people from Ntuusi Rural, Kyeera, Ntuusi Town Council, Nabitanga and Lwemiyaga sub-counties that make up Lwemiyaga County.
Patients, caregivers and other guests are moving in and out of the centre. Inside the health unit, nurses and midwives are attending to patients in the long queues.
At 12:30pm, a motorcycle arrives at the centre carrying Ms Monica Asiimwe, an expectant mother, aged 30. She is hastily supported off the motorcycle, quickly placed in a wheelchair and wheeled to the maternity ward by a midwife as her husband follows behind, carrying essentials needed during labour. The panic exhibited in the process is enough to show that the mother is already in critical condition.
Within minutes, the midwife emerges from the ward, briefs the husband, who starts making frantic telephone calls.
“To save her life, the husband has to take her to Sembabule Health Centre IV. She urgently requires a C-section, which we cannot perform here,” says a midwife who prefers anonymity.
Luckily, Asiimwe is taken to Sembabule Health Centre IV and she delivers her fourth child by Ceasarian section three hours later.
“I thank God who has saved my life. When I was delivering my third born at Ntuusi Health Centre IV, I narrowly survived losing my life. I cannot blame them [staff] but I blame the leaders who have failed to equip the facility with necessary equipment and man power,” she says.
Ms Asiimwe is not the only one frustrated by a dysfunctional health care system in the area.
Ms Christine Naturinda, a mother of two and resident of Kabukongote Village, says she was lucky that she had normal deliveries at Ntuusi health Centre IV but she witnessed her colleague die after her husband delayed to hire a boda boda to take her to Sembabule Health Centre IV.
Ms Naturinda says her colleague had arrived at the health centre early and the nurses tried to do their best but they realised late that her condition needed Caesarian section which they could not perform and referred her to Sembabule Health Centre IV.
Uganda’s healthcare system works on a referral basis. If a given facility level cannot handle a case, it refers it to a unit at a higher level.
Ordinarily, a health centre IV should have a senior medical officer and another doctor as well as a theatre for emergency surgical operations.
According to the National Health Policy, the health centre IV is also supposed to provide blood transfusion services and comprehensive emergency obstetric care to a population of 100,000 people. It normally acts as the mini district hospital.
But for five years now, the theatre at Ntuusi Health Centre has been closed. Surgical operations were suspended after the facility lacked anaesthetic assistants despite the district service commission advertising the vacancies in the media three times.
This has seen expectant mothers pay the price since 2013 as Mr Robert Ambikire, the sub-county male councillor, recounts.
“Mothers go through that rough experience where they travel long distances to access better medical care services. Imagine a mother comes from far as Lwemiyaga Sub-county and reaches Ntuusi for delivery. She is then referred to Sembabule because the theatre is dysfunctional!” Mr Ambikire says.

Risky options
Ms Judith Kamasazi, a resident of Bwogero Village, says the experience they go through while trying to access antenatal care and during delivery is unimaginable.
“We have been sensitised about the importance of delivering in health facilities but sometimes we find ourselves running to traditional birth attendants because they are nearer,” she says.
She says an expectant mother in her village, who needs to undergo a caesarian operation requires Shs80,000 to hire a boda boda at night to reach Sembabule Health Centre, Rusheere Hospital, Kiruhura District or Mubende Hospital. The three health facilities are about 40kms away. In 2016, Dr Elly Muhumuza, the Sembabule District chairperson, promised that surgical operation services at Ntuusi Health Centre IV were to resume soon and appealed to residents in Lwemiyaga County to bear the inconveniences of being referred to Sembabule Health Centre IV.
“We could not raise enough funds to train health workers for the two health centres at once, so we decided to first train two from Sembabule Health Centre IV,” Dr Muhumuza said.
But the theatre at Sembabule Health Centre IV had been dysfunctional for three years.
In this case, mothers for C-section were referred to Masaka Regional Referral Hospital, about 60kms away.
Dr Charles Matovu, the district health officer, acknowledges that the theatre at Ntuusi health centre has been dysfunctional but revealed that the district council has approved a supplementary budget request of about Shs10 million to train two nurses in anaesthesia at Masaka hospital and later deploy them at the facility.
The nurses were expected to finish their six-month training in March and services were to resume in April because there was need to first renovate the theatre as Dr Matovu notes.
But Daily Monitor has learnt that only one nurse returned to the facility and surgical services are yet to resume. A healthy worker at the facility, who preferred anonymity in order to speak freely about the challenges at the health centre, explained that the problem lies in lack of blood transfusion services due to lack of a fridge where to store the blood.
“The doctor said he cannot risk operating mothers when the hospital has no blood to avoid the likely grave uncertainties,” the health worker disclosed.
The worker said this has prolonged expectant mothers’ woes because they are still being referred to other distant health facilities.

Spillover effects
Dysfunctional health centre IVs have, according to Masaka Regional Referral Hospital authorities, seen an influx of expectant mothers at the facility amid shortage of midwives.
Mr Edward Kabuye, the hospital administrator, says many of the referred mothers arrive late which puts their lives and the babies in danger.
Annually, the maternity wing at Masaka Regional Referral Hospital conducts about 2,500 C-section cases, according to the hospital records, with many being referred from lower health centres in the eight districts in the sub-region.
“Mothers move from as far as Sembabule, Kalungu and Bukomansimbi districts and in most cases, they come late at the hospital with intricate cases that require urgent attention, which sometimes could not be readily available since we have a shortage of midwives,” says Dr Gonzaga Ssenyondo, the head of the maternity department.
He adds that there is a need to fully support health centre IVs within the area such that the load at the regional referral is reduced.

Maternal services

Causes. The Ministry of Health’s strategic plan identifies lack of health centre facilities providing emergency obstetric care as key underlying causes of maternal and neonatal mortality.
Crisis. The 2015/16 annual health sector performance report indicates that there is a severe shortage of anaesthetic officers. The report shows that staffing at district level stands at 27 per cent, where, out of the 878 needed officers, only 238 are filled.