Last week we woke up to the sad news of the death of Angel Nansubuga due to alleged neglect during child birth. Nansubuga is only one out of the many women who die due to pregnancy and birth related complications (maternal deaths) every year. The only difference with Nansubuga is that her kinsmen protested the circumstances under which she died. According to the Uganda Bureau of Statistics, 438 women out of every 100,000 livebirths die due to pregnancy and birth-related complications.
Bleeding which is said to have led to Nansubuga’s death has been the number one cause of maternal deaths for the last one decade. This is well documented in the Ministry of Health reports which are submitted to Parliament every year. Isn’t Parliament alarmed by these many reported maternal deaths?
Since the health workers are subject of investigation, I will be selective on what to discuss regarding the health workforce. One may ask, are health workers behind all the maternal deaths which occur in Uganda every year? Of course, not.
Can we then say that parliamentarians do not know the reason as to why Uganda’s maternal mortality remains high? I presume they know, but just in case they don’t, I would invite them to probe all the maternal deaths in the country and fix this issue! Otherwise, they don’t have to look very far, last year, the Ministry of Health (MoH) highlighted in its annual report that some of the underlying causes of maternal mortality are; lack of blood supplies and consumables and, inadequate health workers (numbers and skills). These have been articulated in the maternal death audit reports – “why they die”. The parliamentary probe into Nansubuga’s death could have started with this report before going to Mityana.
Nevertheless, it is not too late to make use of this information to gain a comprehensive understanding of the maternal mortality problem in Uganda. In my view, there is deep seated health system challenge that needs to be addressed if we are to accelerate the reduction in maternal mortality. My worry though is that we might miss the bigger issue as we hunt down the nurse who asked for Shs5,000 from Nansubuga.
In 2011, Parliament seemed to have come out to decisively address maternal mortality issues. In its sitting on December 15, 2011, Parliament debated and adopted seven resolutions which they thought would fix the problem of maternal mortality. For today’s purpose I will reflect on resolutions one and six.
Resolution one; “Parliament tasks government through the Ministry of Health to strictly enforce maternal death audits and take action on the established causes; Resolution six; “Government should compile and table to Parliament annual reports on the status of maternal health in the country with full maternal mortality audit reports and that Parliament shall indicate a particular day to debate this report and propose the way forward”. Whatever happened after these good speeches, you and me can only guess. Otherwise as it appears, Parliament has gone back to start afresh, yet this would have been the time to bring back those resolutions and review progress.
My view is that even if we fixed the problem in Mityana Hospital, we would not have solved the bigger problem of maternal mortality which occurs everywhere in Uganda. Is Parliament then going to probe all the maternal deaths that occur every year? I don’t see this happening. The maternal death audits have simplified this work. All Parliament needs to do is to use these reports to take the decisions that matter. Financing the health sector adequately and then holding MoH accountable are key to conclusively dealing with the maternal mortality problem in the country.
Mr Mukuru is a PhD fellow and Member of the SPEED initiative – Makerere University School of Public Health.