Challenges and opportunities in reducing maternal-child deaths

Pregnancy, pregnant women, maternal- child health

In my last article, I attempted to discuss the three delays in the maternal-child health discourses. I offered insight into their implication in practice and research. In this article, I will share briefs of some of the outstanding issues from my scoping review for a research project.

I have chosen to expound on the issue of maternal child health as stipulated in the Millennium Development Goals (MDGs) to elicit public debate. The purpose of which, is to shed light on the predicament of pregnant women in the inaccessible and deteriorating antenatal and emergency services in Uganda. The health of a woman is a key determinant of the health of the household. Undermining the health of women equally diminishes the society’s pursuit for economic prosperity.

MDG goals four and five are specific to the reduction of maternal child mortality rates among expectant mothers.  This topic interests me because in many studies and prevailing literature, Sub-Sahara Africa (SSA) has been found to be a commonplace for women to die during the course of pregnancy (54% of all global annual maternal deaths due to pregnancy). There are many causes for the malignancy of this problem, but what is important to note is that most of the underlying causes of these deaths are easily avoidable or preventable.

I have carried out an extensive but preliminary literature review on this subject of maternal –child health dyad. Out of the over 600 peer reviewed research articles, I found common and recurring themes. Top among these are; lack of political will to prevent, arrest or reverse deaths associated with pregnancy; that although fertility among poor and rural SSA is high, pregnancy related complications and deaths are associated with conditions of poverty. Communities that are isolated due to lack of infrastructure (Roads and telecommunication) and those that lack access to professional Emergency Obstetric care (Emoc), incur more deaths whether due to pregnancy or any ailment and; certain cultures, traditions and customs are enablers in facilitating these deaths.

Success stories have been registered where women have been able to generate household income and to support their pregnant peers to seek professional care. Other areas of success recorded involves rural communities indulging in cost sharing for public health services, where minimal membership fees is paid at village and sub-county levels, like in Rwanda which promotes performance based financing to healthcare. In some places, women incentivize Gaenecologists and Midwives to frequent their local health centers, like it is in Zegoua town of 22,000 people, situated 500 miles south of the Capital Mali, Bamako. Groundbreaking works have been reported in Bangladesh, Sri lanka, Tamil Nadu in India, South Africa and Egypt.

The high maternal-child mortality rate in Uganda is one that is very shameful. Our neighbor Rwanda, with functional 395 peripheral health centers, 40 district hospitals and three referral hospitals, have registered far better health outcomes than Uganda and they could inspire us to suceed.

I contend that Uganda has capacity to contain and eliminate maternal child deaths through its elaborate health institution structures. The problem which undermines the efficiency of the healthcare system is chronic lack of political will to invest in area of the economy that matters the most. Our healthcare system is easy to streamline and to strengthen, especially under the local government system. Lack of funding, poor leadership and lack of political will remain the key impediment to healthcare service delivery.

If all local authorities were encouraged to place health as priority on their political agenda, most of the health problems could have been eliminated. Most of the ailments in Uganda are primarily associated with poor hygiene and poverty as a consequence of lack of resources at the rural and peri-urban Uganda. If these fundamental components of health were addressed, the pressure on the healthcare system would be significantly alleviated.

According to WHO studies, on the average, a rural SSA woman spends 4 hours of the day looking for water and requires same time to collect firewood for preparing meals. The woman has no time to attend to her own health, such that when pregnancy comes, it finds her body already weakened. Unfortunately, the plight of the ordinary Ugandan woman of child bearing age will never be addressed until tragedy befalls a daughter or wife of a politician while giving birth at home or abroad.

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Blinding loyalty to NRM is recipe to Societal Poverty

ELECTIVE POLITICS & POVERTY

This week presented yet another onslaught of NRM from a by-election in Butambala.  The DP Party has made a significant inroad in a place once considered a bastion of ruling NRM. Butambala is a remote district where every elected person claims to be NRM. The tales of Butambala also illuminate a relationship between supporting NRM and increasing economic disparity. People in Butambala are among some of the poorest in peaceful Uganda and Butambala stands as a replica of places with blinding loyalty to the NRM.

The victory of a former UYD firebrand and the founder of Popular Resistance Against Life President (PRAP), Mr. Muwanga Mohamad Kivumbi in Butambala is a defining moment for the NRM.  It illustrates a growing consciousness that in the last 26 years of monopoly of power, the NRM has not been honest to its followers. The NRM treated those that opposed it with much contempt and detestation and considers any forms of opposition as an act of rebellion. In retaliation, opposition figures are harassed, arrested in a manner not befitting of modern human treatment and jailed without charge, just to humiliate and disengage.

What has also been evident is that most of the areas that have offered blinding allegiance to the regime have remained in perpetual state of poverty. The areas that have been actively engaging the regime have attained better results in reducing their poverty levels and self-sustenance.  Many cases are there to illustrate this; take for instance Karamoja, Busoga, Bunyoro and Toro. These areas have been the poorest and most neglected regions in Uganda. Had it not been for the recent buzz in oil exploits, Bunyoro would remain a neglected region of Uganda. What Bunyoro has shared in common with Busoga are the stunning number of people living below the poverty line; those demobilized by jiggers and other adverse living conditions. Moreover, these regions have been very peaceful for the most part of the last 26 years and they have supported the NRM overwhelmingly for the same period of time.

What then are the theoretical underpinnings that can explain the similarities in regional decadence if it is not closely associated with the rather deceptive and exploitative nature of the NRM regime? There are few explanatory models to this dilemma; first, we could advance the theory of Acquired Helplessness to explain the presumed relationship between variables “supporting NRM” and “increasing levels of poverty (societal decay). Secondly, we can advance the theory of resilience to explicate the ability for self-sustenance and sporadic socio- economic growth in those areas that have maintained a mixed blend of anti/pro NRM methodology.

The theory of Acquired Helplessness is prevalent in health sciences and more so in rehabilitation sciences especially among the seniors, those recovering from illness or those enduring prolonged illnesses such as stroke and so forth. This theory posits that to provide all round support to a person in need only helps in his/her deterioration of functional abilities. It urges caregivers to promote functional skills for self-help among those whose functional abilities have been impaired by illness. The typical “NRM society” is presented in this model as one that has been demobilized by many illnesses, most importantly, corruption, injustice and impunity. The NRM is the causal agent in society that wreaks havoc on society’s functional ability to exercise their will and rights. By stealing votes, it impairs that faculty of society that should be making competent choices, thus leading to marginalization. Just like a sick body, a society riddled with such malaise, cannot function. Given the patronage, these societies quickly acquire a mindset of helplessness, the conviction that no amount of self-exertion can produce results - their true voices will never be heard and they have nothing to do about it. Their allegiances are therefore manufactured and their functional abilities thwarted remorselessly. So they are conditioned to support the regime at a cost of sheer negligence.

To the contrary, the regions that have utilized mixed methods by tolerating both NRM and opposition among its ranks have fared much better. These communities like Buganda (Luwero), Acholi, Teso, Lango etc., have developed competent faculties upon which they regulate their aspirations and strategize for national resources as serious contenders. One would assert that these regions are more conscious politically and economically to understand the true nature of the NRM. These regions have also endured the worst forms of vertical violence in the last 26 years to become resilient. Resilience is the ability to bounce back from adversity. Generally, these societies have illustrated self-reliance, independence of thought and higher levels of accountability.

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