Skilled health workers saving Uganda’s mothers

Monday April 15 2019

Josephine Nabukeera

Josephine Nabukeera 

By Josephine Nabukeera

Mastula recalls stumbling into Isingiro District’s Kashamba Health Centre IV, heart racing and with swollen legs.
It was not long before the nurses and midwives discovered she had developed high blood pressure, putting her at risk for pre-eclampsia/eclampsia, a condition she was told was a dangerous and occasionally fatal condition.

Kicking into high gear, the dedicated practitioners had examined her and given her medication after which they suggested she return to the facility every couple of weeks for close monitoring until her delivery. She shares this experience with a thoughtful gaze, “my boy, now four years, is a miracle child considering the ordeal I went through while I was pregnant with him.” she adds. Luckily, the skilled nurses and midwives detected this condition early hence Mastula surviving to share the tale.

Listening to Mastula’s story as I waited to meet with the health workers was a rude reminder. Lately, many mothers in Uganda have not been as lucky and have succumbed to pre-eclampsia. It presents with high blood pressure, sudden weight gain, swelling of the face and hands are some of the clear symptoms of pre-eclampsia.
Detecting pre-eclampsia/eclampsia early is vital for the health of both mothers and their babies. This is so that the condition can be closely monitored and managed by health workers to avoid severe complications in pregnancy and around child birth.

Pre-eclampsia/eclampsia are on the rise in Uganda and contribute heavily to maternal mortality. According to Uganda’s Reproductive, Maternal, Newborn, Child and Adolescent Health Sharpened Plan (2016-2019), pre-eclampsia and eclampsia claims 12 per cent of women lives during childbirth annually. Pre-eclampsia puts a mother at a higher risk of still birth which often results into severe bleeding, preterm birth among other fatalities.

Pre-eclampsia/eclampsia are just one category of the numerous conditions that threaten the lives of pregnant women. It astounds me that pregnancy should continue to be a life-threatening risk for women. With appropriate and timely access to quality healthcare throughout pregnancy, this should be a problem of the past.

The government has tirelessly worked to put measures in place to reduce maternal mortality over the past few years and their efforts are commendable. However, despite this progress, a lot more needs to be done to ensure that no pregnant woman dies before or during childbirth.
This is achievable if there is access to equitable quality of care across the regions of the country. Quality healthcare requires that mothers are assessed and examined by skilled health workers at regular antenatal visits. This is in addition to delivering in a safe and well-equipped hospital environment.

If we can improve maternal healthcare, we can improve entire health systems and strengthen families. When a woman dies from pregnancy complications or childbirth, her family and community suffer.
The fate of Ugandan women lies largely in the hands of health workers - the midwives, who if unable to detect such complications early enough, could lead to death. Well-trained and skilled health workers make all the difference. I like that the government is reinforcing its commitment to improve quality of care in maternal and newborn services through partnerships.
Jhpiego, in partnership with Ministry of Health, builds capacity of health workers in different parts of the country with the skills, knowledge, and confidence to improve the quality of care of services.

This training plays a significant role in in preventing the needless deaths of women and their babies during pregnancy, childbirth, and in the immediate post-delivery.
Mothers like Mastula deserve the best quality of care we can offer. As we make these demands of health workers, I also implore the government to improve remuneration and an enabling environment for service providers to keep them motivated.

Dr Nabukeera is the head of programmes, Jhpiego Uganda.