TRANSPORT & MATERNAL-CHILD HEALTH
In my previous elicitation I argued that Uganda’s healthcare system is one that could be fixed with political will to enforce intersectoral collaboration at governmental levels. I educed that the healthcare system requires leadership, ideology and funding. This article is a continuation of the articulation of the Delay Factors responsible for high maternal-child mortality in Uganda. It is premised that the persistent failures of the healthcare system is attributable to general system wide failures in public the public transportation that impede access. In evaluating the efficacy and efficiency of the public healthcare system we must include the contribution of other functions of governments that provide social security and enhances equity. The healthcare system is part of the fabrics of what constitute social services and a driving force for a robust economy that does not function in isolation.
The health of pregnant women and children largely depends on mobility potential. One of the delay factors that lead to the death of pregnant women and children is the delay to reach healthcare facility. The World Health Organization estimates that 40-60 percent of the people living in developing countries live more than 8kms from healthcare facilities. Poor roads and mobility resources including high transportation costs are the key delay factors that facilitate mortality among vulnerable children and pregnant mothers. When a pregnant woman experiences complications, she has between 6-12 hours before she can access qualified emergency care and yet most perinatal deaths occur during labor and delivery or within the first 48hrs.
The timely access of healthcare services is predicated on availability of emergency means of transportation, good acess roads and ready reception at the point of care. Transportation facilitates access to health care facility and determines well-being of maternal child dyad. Moreover, one’s ability to be mobile comes with power and prestige. The World Bank recognizes that mobility, power and well-being are closely link to gender inequalities. The ability of the male to own and control modes of transportation also controls the mobility of members of the family and that determines the health of that family.
No matter how well resourced a healthcare facility is, if it is not accessible the people will not use it. There grows apathy and sense of alienation between the people and the facility. This is why most hospitals operate ambulance services at a minimal access fee, to consolidate community connection and bridge the service gap. The Millennium Development Goal recognizes that a robust healthcare system is a critical and fundamental social service necessary for the attainment of economic goals. However, the slow trends in achieving MDGs in sub-Sahara Africa are premised majorly on access to healthcare facilities.
Further, a robust healthcare system is key driving force to any economy and therefore integral to the very functions of the state. Healthcare system’s failure is then not the organic dysfunction of the system itself, but the capitulation it faces from the mainstream - that is how well integrated it is, in the economy. To appraise Uganda’s healthcare system we must pay due regards to issues of access, public health policies, government funding priorities, leadership and underlying ideology. There is need to appraise the healthcare system within the performance context of the incumbent regime. A failed healthcare system signifies failures on the part of that administration as a whole, not of the system per se.
There are crucial areas that a twenty-first century healthcare system can fail; when the system adheres strictly to outdated biomedical models which views health as the interplay between infirmities or lack thereof and; when the system selects downstream approaches to healthcare and neglects the fundamental upstream aspects. Investment in public health systems and deliberate focus on social determinants of health poses the greatest opportunity for strengthening the healthcare system in Uganda and lessens the burden of downstream biomedical care.
To improve healthcare service delivery to the population, the government must enforce and encourage all sectors to place health thinking in its planning agenda. When building roads, the driving force is not how much to be made in profits per kilometer, but rather, how useful the road will be in facilitating access to nearby social services. The obsession for highways and superhighways underscores the needs for rural access and at local levels. There must be increased mapping of mobility entitlements and accessibility patterns as recommended by the WB. Improvement of information technology in the meantime could tremendously fill gaps poised by distance.
I have established that there is a strong relationship between transportation and maternal-child mortality in Uganda and by extension in sub-Sahara Africa. The world over, governments have invested in infrastructure to kill “distances” and to avert from “womb to tomb” episodes that characterize the experiences of reproductive women in Uganda. Healthcare is integral and primal aspect of the functionalities of the government. Its failures reflect the failure of the system as a whole.
END.
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