While they are supposed to be thrilled, mothers in Uganda are instead still terrified by what will happen to them during and after delivery owing to the inefficiencies in maternal health.
Although those in the rural settings with most substandard health facilities are more at risk, urban dwellers who flock high class private hospitals have equally died while pregnant or within 42 days of termination of pregnancy known as maternal mortality.
On May 4, last year, news trickled in that former WBS TV journalist Nuliat Nambaziira had died due to postpartum heamorrhage only days after giving birth. At her burial, mourners accused the hospital where she had died, of negligence that they claimed led to her death.
On the fateful day, Nambaziira joined the 368 deaths of mothers per 100,000 live births annually, according to the latest statistics in the 2016 Uganda Demographic and Health Survey (UDHS) released by the Uganda Bureau of Statistics (Ubos). Although the ratio dropped from 438 in 2011, the numbers are still high and far from the Health sector Development plan 2015/2016 -2019/2020 to reduce it to 320 per 100,000 in 2020.
The maternal mortality ratio rate is also still higher compared to the Sustainable Development Goal 5 targeting to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. The stagnation, however, prevails in the face of various interventions by both government and donor funders in ensuring skilled manpower, sensitisation and increasing family planning uptake, among others.
What to do
Prof Peter Waiswa, a health systems researcher at Makerere University Centre of Excellence for Maternal Newborn, says government has failed to provide strong leadership in reducing maternal mortality the way it has done in the field of HIV/Aids and malaria where the country has registered tremendous success.
“There [malaria and HIV eradication] we have financed human resources and quality care but for maternal health, we have concentrated more on paper and policies,” Prof Waiswa states, mentioning that the health sector has been left to the donors who have their own priorities.
In the past decades, Uganda has seen a great decline in the prevalence of HIV/Aids from 18 per cent in the early 1980’s to the current six per cent prevalence rate. On the other hand, the country has seen a decline in malaria prevalence from 42 per cent in 2009 down to 19 per cent.
On the issue of private facilities equally registering maternal mortality, Prof Waiswa mentions that: “Private hospitals are not completely private because since they are not so profitable, they are compromised on a number of things such as staff.”
Similarly, Dr Haruna Mwanje, a gynaecologist and fistula surgeon at Mulago National Referral Hospital, says the policy makers have got to look at the factors contributing to reduced maternal mortality in other countries so they can be employed here. “Family planning uptake has to be increased to help women have children when they are ready to take care of them, ensure attendance of antenatal visits as well as provide emergency services,” Dr Mwanje says.
In countries where maternal mortality has been reduced, uptake of family planning services has been promoted and women only have children by choice, he adds.
For these to be achieved, Dr Mwanje says it has to be a combined force by both government and the public as well as other stakeholders to regulate the number of women who deliver at a time without pointing fingers because government cannot provide for everyone.
The fertility rate in Uganda currently stands at 5.4 per cent in 2016 down from 7.4 per cent in 1988, meaning that a woman in Uganda can have about five children in her life time, according to 2016 UDHS
The reduction in fertility rate was attributed to an increase in contraceptive use among married women aged between 15 and 49 but noting that more needed to be done. Indeed, the ministry of Health has acknowledged that the low per capita investment into the health sector has affected implementation of some initiatives and the subsequent stagnation in the reduction of maternal mortality.
The rural challenge
Sarah Opendi, the State minister of Health for General Duties, admits that there have been gaps in providing timely health services to mothers, especially in rural areas where more than 308 sub-counties do not have health centre IIIs. “Some of the health centres do not have human resource and equipment…and some health centre IVs, which can carry out ceasarean sections are not functional,” Opendi explains.
She notes that government is currently focusing on health centre IIIs and has secured funds to construct 105 this year alone. Government also aims to equip, attract and retain health workers.
Government has also integrated the new World Health Organisation guidelines to double the number of routine antenatal care visits from four to eight for better monitoring. She adds, however, that people must also have personal responsibility.
Sarah Opendi, the state minister of Health for General Duties, says government is currently focusing on health centre 111s and has secured funds to construct 105 this year alone. Government also aims to equip, attract and retain health workers.
She adds that government has also integrated the new World Health Organisation guidelines to double the number of routine antenatal care visits from four to eight for better monitoring. Dr Haruna Mwanje, a gynaecologist and fistula surgeon at Mulago National Referral Hospital, says it has to be a combined force by both government and the public as well as other stakeholder to regulate the number of women who deliver at time without pointing fingers because government cannot provide for everyone.