How pregnant women struggle to access health-care in Kagadi
Expectant mothers at Kitebere Landing Site. PHOTO/ BARBRA NALWEYISO
What you need to know:
- On paper, the rule is that every sub-county in the country should have a Level III health facility. However, in Kagadi district, this reality is far from the truth, with the future of a number of pregnant women uncertain. The government’s failure to upgrade some health facilities to provide adequate health services, the lack of ambulances, and the poor road network in some places are a sobering reminder of the inequalities that persist in Uganda’s healthcare system. As Barbra Nalweyiso reports, this negligence has ensured that mothers continue to endure the pain of losing newborn babies due to systemic failures.
Ndaiga sub-county in Kagadi District, in western Uganda, is nestled between rugged hills and Lake Albert. The sub-county is home to over 20,000 residents. However, despite its population, the area is served by only one Level II health facility, leaving pregnant mothers to struggle to access much-needed health services.
The absence of reliable healthcare infrastructure, combined with challenging geographical conditions, paints a grim picture for the region's maternal health.
The sub-county’s roads are poorly maintained, often deteriorating into muddy paths in the rainy season, making them impassable.
Pregnant woman jumping on a boda-boda
With no alternative transport system, residents are grappling with the kind of isolation that turns routine medical visits into dangerous expeditions.
The community's reliance on fishing as a primary economic activity offers little financial cushioning for emergencies, particularly for pregnant women who require urgent attention.
For these women, the question is not just about accessing healthcare; it is about survival.
A mother’s struggle
Piyer Anyerango, a 32-year-old mother of two from Kitebere landing site, is nine months pregnant. Her pregnancy is complicated, but it has never been monitored at a health facility. She relies on a traditional birth attendant (TBA) for antenatal care because her home is 20 kilometers away from Ndaiga Health Centre II.
“I expect to go into labour anytime soon. Like my previous pregnancies, this one also has complications. I often experience pain in my lower abdomen. My TBA advised me to visit her every three days so that she can physically align the baby. She says it is not positioned properly in the womb,” she explains.
Last year, Anyerango lost a baby during delivery at the home of her TBA. Despite the tragedy, she continues to depend on traditional medicine due to the challenges of reaching the health centre.
“Last year, at five months, I experienced sharp pains, lost weight, and my stomach shrank. This pregnancy is no different. Although the condition requires medical attention, I cannot travel to Ndaiga Health Centre II because the journey is risky, and the health center often lacks medicine,” she said.
The 20-kilometre journey from Kitebere village to Ndaiga Health Centre II takes an hour by motorcycle due to the muddy, hilly terrain. In some places, the motorcycle cannot transport passengers, forcing pregnant women to walk for long stretches. Traveling by bodaboda costs at least Shs50,000, a significant expense for people depending on fishing.
The safer alternative is to travel by boat. However, hiring one for a roundtrip costs Shs300,000, far beyond the means of most families. But even when women manage to reach the health center, the lack of essential services compounds their struggles.
Kagadi district chairperson, Yosia Ndibwami
Margaret Munguryek, a resident of Songalawo landing site, recalls losing her third child at Ndaiga Health Center II due to delays in receiving medical attention. Now, she walks over 40 kilometers to Kyaterekera Health Centre III for antenatal care.
"However, my plan is to stop going there at seven-months when the journey becomes too arduous. I will deliver at home with the help of a TBA,” she explains.
For many women in Ndaiga sub-county, giving birth at home or with a TBA is the only viable option.
Last ditch effort
This newspaper’s efforts to investigate why many mothers avoid the health facility revealed systemic challenges. Helping two expectant mothers - Ruth Coladine and Grace Ajara - to secure bodaboda transport to Ndaiga Health Centre II is an ordeal.
Due to the expense, the two women sat on one bodaboda. The 20-kilometre journey took us over two hours due to the muddy condition of the road. In some stretches, for their safety, the women had to get off the bodabodas and walk.
Aisha Justine Twebaze, the Kagadi health educator
Unfortunately, upon arrival at the health facility, they were met with disappointment. The midwife had been absent for four days after she left work to attend the burial of a relative.
Grace Ajara’s pregnancy is almost nine months. The 28-year-old recounts the harrowing journey.
“We traveled for hours on a rickety motorcycle only to find the midwife absent. I feel pain all over my body. I wanted the health worker to check the progress of my pregnancy since I am nearing my due date. I have been told to return on Thursday next week, which is really far. And I do not have the money to hire a bodaboda,” she laments, her eyes heavy with despair.
Ajara has not made any preparations for her time in labour and fears for her safety. Having been abandoned by her husband during the fourth month of the pregnancy, she now depends on her brother, who is a fisherman, for support.
Esau Opio Isingoma, a member of the Village Health Team (VHT), highlights the dire consequences of not addressing these structural challenges.
“Last year, two women in our village died during childbirth because they could not reach the health center in time. Transport is a major issue here. Sometimes, we have to carry onto our shoulders women who are experiencing labour pains so that we can rush them to the facility,” he said.
Isingoma decries the reliance on TBAs saying it increases the risk of mother-to-child HIV transmission.
“TBAs are not trained to prevent HIV transmission, leading to a rise in the number of children born with HIV in this area. Frequent pregnancies, often within months of each other, also result in complications such as bleeding due to the uterus not being fully healed,” he warns.
State of the road used to access Ndaiga Health Centre. PHOTO/ BARBRA NALWEYISO
Inadequacy of the health facility
Residents report consistent shortages of drugs and staff at Ndaiga Health Centre II. Abdul Karim Hassan, the chairperson of Songalawo village, recounted a failed initiative to transport mothers to access antenatal care.
“We once organised a program to take women to the health center for antenatal care. We took 56 mothers but the services were poor. On another trip, we transported 76 mothers and when they reached the health centre, they were only given magnesium tablets. The staff could not handle the numbers,” he says.
On that trip, one of the women went into labour, but the health workers could not attend to her. Hassan returned her to the boat and she was taken to Kituuti Health Centre IV in Kikuube District. The baby did not survive.
“You can imagine the emotional toll this takes on the families. Imagine the pain of traveling long distances only to return home after failing to get medical assistance. This discourages women from seeking antenatal care. That is how our program of helping to transport women failed,” he says.
Aisha Justin Tumwebaze, Kagadi district’s health educator, acknowledges that Ndaiga Health Centre II cannot meet the maternal healthcare needs of the community.
“Transport to the facility is expensive and there are inadequate drug stocks. Retaining health workers at that facility is also difficult due to the harsh living conditions. That is why we only hire men - four men. These male health workers cannot offer much help to a woman seeking antenatal care or one in labour,” she explains.
Tumwebaze adds that the district’s lack of an ambulance complicates referrals. Even the lone ambulance at Kagadi General Hospital broke down.
“The Ministry of Health failed to recognise Ndaiga sub-county as a hard-to-reach area and this has limited access to funding and support. Sometimes, the sub-county can only be accessed by water transport,” she laments.
Abdul Kharim Hassan, chairperson Songalawo village
Dim ray of hope
Yosia Ndibwami, Kagadi district’s LCV chairperson, expresses optimism about future improvements.
“We have submitted requests to the government to upgrade Ndaiga Health Centre II to Level III in the Financial Year 2025/2025. This is because the facility is crucial due to its proximity to landing sites and the border with the Democratic Republic of Congo (DRC). The upgrade, however, remains a plan on paper, with no immediate timeline for implementation,” he says.
The challenges in service provision in Ndaiga sub-county reflect a broader crisis in Kagadi district, where four of the 35 sub-counties lack health facilities. The district’s limited resources and reliance on external funding make it difficult to address the growing healthcare demands.
In the absence of government intervention, communities like Ndaiga are left to their own devices. The result is a cycle of poverty and ill-health that perpetuates the region’s struggles. The plight of pregnant women in Ndaiga underscores the urgent need for holistic interventions, improved infrastructure, better staffing, and targeted government policies.
In the meantime, mothers in Ndaiga continue to rely on hope, resilience, and traditional practices to navigate their pregnancies. Those who can afford to, transport themselves to the DRC for better health services, at a cost of Shs500,000 per roundtrip on Lake Albert.
As Kagadi district continues to grapple with its healthcare challenges, the resilience of its people offers hope. But hope alone cannot save lives.
