Letter to Inter-Parliamentary Union delegates on maternal and child health

Wednesday April 4 2012

By Kakaire Ayub Kirunda

Dear delegates to the 126th Inter Parliamentary Union meeting,
Welcome to Uganda. I hope and pray that you will have fruitful deliberations on all the issues lined up on your agenda.

Meeting in Africa and having “Access to health as a basic right: The role of parliaments in addressing key challenges to securing the health of women and children” as one of your agenda items comes at a critical time. We are left with only three years to the 2015 target of meeting the Millennium Development Goals (MDGs).

In this part of the world, only a handful of countries are likely to meet the MDGs 4 (reducing child mortality) and 5 (improving maternal mortality). Unfortunately, my country Uganda is one of those in this category when it comes to these two MDGs.

Latest progress reports published by UNDP conclude that although Uganda appears likely to achieve targets for Goals 1, 3, 6, 7 and 8, which respectively are to: eradicate extreme poverty; promote gender equality and empower women; combat HIV/Aids, malaria and other diseases; ensure environmental sustainability; and develop a global partnership for development, progress towards Goals 4 and 5 is uncertain. Recent media reports quoted Uganda’s Health minister saying infant mortality has gone down from 76 in the year 2006 to 54 per 1,000 live births in 2011, while maternal mortality has also reduced from 435 to 345 per 100,000 live births in the same period.

MDGs 4 and 5 are closely interlinked because what affects the health of a mother will ultimately have ripple effects on the child. For instance, if a pregnant woman delays at home because she cannot access transport to the hospital and develops complications, chances of losing her or her child or both are high. Equally, when she eventually gets to a health facility, if there are no health workers or requisite supplies, there could be dire consequences for either or both. While your Governments promise better roads to ease movement -including transporting women in need of emergency care and health facilities equipped with requisite supplies and personnel, this is not happening.

In Uganda, we have many impassable roads that even wheeling a pregnant mother on a bicycle to the hospital to deliver is next to impossible. We also have health facilities (some level 2 ones) manned by nursing assistants and where we have qualified ones, they are few, and overworked, leading to burn-outs and subsequently poor attitude and absenteeism. And worse still, many health facilities experience frequent stock-outs of supplies and drugs, leaving health workers with no alternative but to ask the patients to buy the missing items. Evidence shows that all these combined, force many women to deliver without skilled attendants, putting their lives at risk. Their newborns are equally at risk because they can’t be assessed by qualified personnel for any apparent danger signs.

I do not need to remind you of your three key roles of representation, legislation and oversight. However, to do this, you need to base your work on evidence, and this needs to be done as soon as yesterday. Therefore, if you are to help your constituents and governments, especially in countries struggling to meet MDG targets 4 and 5, ensure that your governments prioritise the use of their limited resources on increasing the number of trained health workers, improving their pay and availing the supplies required to deliver quality services.

Similarly, useful policies that could lead to improvements in maternal and child health-- now gathering dust in some offices-- should be dusted and put to use. The Abuja Declaration in which African countries promised to up the health budget to 15 per cent of their national budget remains unimplemented. I hope this important conference will provide the impetus needed for governments to ensure that evidence-based programmes that can save the lives of mothers and children are actually implemented.

Mr Kakaire works with the Future Health Systems Research Consortium.

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