Govt, UN disagree on maternal deaths figures

Uganda registers up to 191 maternal and child deaths daily due to lack of access to better health care and the high disease burden, a new analysis of the United Nations (UN) data shows.

This figure, which the Ministry of Health has since dismissed, was unveiled in Kampala last Friday by Dr Othiniel Musana, the President of the Association of Obstetricians and Gynecologists of Uganda (AOGU), during a planning meeting with officials from the Health Ministry.

“Every day, 191 babies and women die in Uganda. That is more than what the genocide would kill. We have many specialists in the country but they are unemployed,” Dr Musana said.

The meeting was convened to develop the National Surgical, Obstetric and Anesthesia Plan (NSOAP) that will enable the country handle around two million Ugandans who fail to access surgical services in the country every year.

Dr Musana added: “People should seek health care in Health Centre IVs because the facilities are near them but since they are not fully functional, everyone wants to go to Kawempe National Referral Hospital. Only 11 percent out of 15 percent of mothers who need Caesarean section are accessing the services.” 

The country, according to 2021 data from the United Nations Children’s Fund (Unicef), lost 69,025 babies who are less than five years old, which translates to 189 deaths per day. 
The deaths include 30,336 male and 38,689 female children, according to Unicef. 

The 2021 figure, however, portrays a decline from 71,323 child deaths below five years in the year 2019, signalling an improvement in service delivery, according to the UN agency. 

The Unicef report on child deaths, however, contrasts the 21,351 deaths that the government indicated in the health sector performance report for the financial year 2020/2021. 

For the death of mothers, at the rate of 338 maternal deaths per 100,000 live births, the country loses around 5,475 mothers annually.

The number of maternal deaths also contrasts with the 1,228 deaths the government indicated in the health sector performance report for the financial year 2020/2021. 

The total number deaths of children under the age of five and maternal deaths combined, according to statistics from the health sector performance report, stands at 22,579 deaths (which is equivalent to 62 deaths per day). 

The news about the high number of infant and maternal deaths coincides with an announcement by concerned Ugandans on Twitter, who last week announced that they will today start a syndicated exposure of the country’s healthcare-related failings on their Twitter handles.

The same group last week carried out a successful virtual protest dubbed #KampalaPotholeExhibition, highlighting major potholes in the city and how Kampala Capital City Authority had failed to fix them.

Dr Richard Mugahi, the assistant commissioner in charge of reproductive and infant health at the Health ministry, told this newspaper yesterday that the figure presented by Dr Musana “is not true for daily deaths”. 

He, however, didn’t give the official or alternative figures.

Defending its data in the health sector performance report, the ministry said: “Information used for compiling the report was both quantitative and qualitative and consisted principally of data generated from the Ministry of Health’s Health Management Information System (HMIS) - District Health Information Software Version 2.3 (DHIS 2.3).”

Associate professor Peter Waiswa, a specialist in health policy and planning at Makerere University and the lead analyst of the report, said about 50 percent of deaths in the country happen at home, and so relying on reports from health facilities is an underestimation. 

He said the UN data is always based on records from government authorities, monitoring of trends and modelling by specialists to come up with the current figures. 

He said the country has not yet done a countrywide survey to determine the exact number of deaths. The last national demographic and health survey was done in 2016. 

Dr Musana, an obstetrician-gynaecologist at St Francis Nsambya Hospital, on the other hand, said not all health facilities are reporting to the ministry through the HMIS. 

He said the data the ministry has, is majorly from public facilities and some non-profit or faith-based health facilities like St Francis Hospital Nsambya.

He said around 40 percent of the health services are provided by the private sector. 
“The ministry is busy planning for malaria, HIV and TB but many people in the country do not have those conditions. People are dying from other conditions. Women are dying because of childbirth, people cannot get surgery for hernias or bone fractures. We need to have the plan to ensure people access the services cheaply,” Dr Musana said.

He added: “Uganda has trained specialists but because the government is not employing them, people are being referred abroad.” 

“Up to 50 percent of health centre IVs are not doing caesarean section due to lack of human resource yet most of them are equipped. The government is deploying doctors to the lower facilities but you find that there are no anesthetists to work in the theatre.” 

Dr Waiswa said mothers die in the health facilities because there is no “blood, sutures (threads for closing surgical wounds), electricity and anesthesiologists”. 

Dr Rony Bahatungire, the commissioner for clinical services at the ministry, while speaking at the Friday meeting in Kampala, said the government is open to proposals from the health experts that improve service delivery. 

“The professional associations should come up with policy proposals to better our work environment and not only come out to advocate or defend positions,” he said.

Dr Bahatungire also said the ministry told health experts to innovatively use the available resources. 

“If you are working at the facility and we find that there are challenges in delivering our mandates, is it possible that we should first make the best use of what has been availed and make sure we have improved our work environment before we start lamenting and start calling for support from elsewhere,” he said.

The commissioner added: “We should be committed to our work and we shall have better input and enjoy our work. When we work together as a team, we can better advocate as government and professionals. We are improving our paediatric surgical services with a partner, in terms of equipping facilities. We are ensuring that we have the human resources to run the facilities.”

Data...source of MoH data 
Information used for compiling the report was both quantitative and qualitative and consisted principally of data generated from the Ministry of Health’s Health Management Information System (HMIS) and District Health Information Software Version 2.3 (DHIS 2.3).

The above is supplemented by the Integrated Financial Management System, Uganda National Household Survey, 2019/20, Uganda National Panel Survey, 2019, National Client Satisfaction Survey, 2020, Annual Health Sector Performance Report 2019/20, Program and project reports and assessments, Local Government Performance Assessment, 2020, World Health Statistics Report, 2021. 

Source of UN health data 
The information is obtained from government authorities, monitoring of trends –by experts and academia, and modelling by health data specialists (epidemiologists).

The reports are generated through the work of the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), which was formed in 2004 to share data on child mortality, improve methods for child mortality estimation, report on progress towards child survival goals, and enhance country capacity to produce timely and properly assessed estimates of child mortality. 

The UN IGME is led by the United Nations Children’s Fund (UNICEF) and includes the World Health Organization (WHO), the World Bank Group and the United Nations Population Division of the Department of Economic and Social Affairs as full members.

UN IGME’s independent Technical Advisory Group (TAG), comprised of leading academic scholars and independent experts in demography and biostatistics, provides guidance on estimation methods, technical issues, and strategies for data analysis and data quality assessment.

UN IGME updates its child mortality estimates annually after reviewing newly available data and assessing data quality. The web portal contains the latest UN IGME estimates of child mortality at the country, regional and global levels, and the data used to derive them.