Death at Birth is still a reality in Uganda

Maternal Child Death

Death at birth in Uganda is still a daily reality. In fact being pregnant, seeking qualified healthcare services, including Emergency Obstetrics Care (EMOC) are pathways to death.  The UNFPA reported that only 13% of Ugandans actually live in urban areas, implying that Uganda as a whole is majorly rural. And yet, majority of the functional healthcare facilities to support maternal-child health including safe pregnancy and delivery are concentrated in urban areas.

As a consequence of this disparity, only 42% of pregnant women were delivering in health facilities. The figure has improved recently, showing that 57% of women are being delivered by skilled labor in healthcare facilities (according to 2012 data). Uganda’s maternal mortality ratio is 310 per 1000 of live births; 5000 mothers still die at birth annually (from a 2010 source) which has also improved. UNICEF has recently upgraded data which shows some improvements in maternity services consumption. For instance, 93.3% of pregnant women are now attending to at least 1 antenatal visits; 47.6% are attending at least 3 antenatal visits. The WHO recommends at least 4 antenatal visits.

The maternal child health in Uganda could improve if the needed services are taken to rural communities where majority of the women live. This effort requires a political will to commit to the Abuja declaration that government should commit at least 15% of its national budget to health. Currently, Uganda has not fulfilled that commitment as health budget remains staggeringly low while health services expenditures are increasing (Mbonye and colleagues, 2012).

There is also need to increase the density for Midwives, Nurses and Doctors from the current 1.4/1,000 to at least 23 as recommended by WHO, for Uganda to be able to meet its Millennium Development Goals. At the current rate, Uganda will only be able to meet those goals by 2035 or even later.

In my home district of Pader, there has been one doctor for the population of 231,700. Dr Ochaya recently passed on, which means Pader has no Medical Doctor! Given its relatively new status, Pader District is disadvantaged in that it does not have a robust Missionary hospital like its neighboring districts of Kitgum and Agago.

 In Uganda, 42% of functional hospital facilities are in the private hard-to-reach for the poor, the Missionary hospitals and NGO operated health facilities. Most of the government facilities are on steady decline; understaffed with some unqualified personnel attending to medical emergencies.

There are many untapped opportunities in the Ugandan healthcare system. The Village Health Teams offer untapped potential for reach to households in rural communities. This team should comprise of Comprehensive Health Nurses with facilitation to provide instant services in rural hard to reach localities. Instead of employing one Doctor in a rural district like Pader, we should transform the health care system into Public Health Units such that the Doctor becomes the director of various health services with emphasis on preventive healthcare services.

The way sub-Sahara Africa is portrayed in literature is as if it is entirely a place of doom where the males wish their wives and children death. This is arbitrary to the fact on the ground. Every African man strives to have a healthy family and suffers grief when a child or wife dies. Therefore, it is incumbent for us to articulate accurately, those social determinants of health which affect the health of these people in rural communities and work on them collaboratively. We need to pay attention to poverty, rural livelihood and opportunities for earning income, the use of income, investment in communities through functional education to enhance health literacy, transportation, clean and safe water, sanitation, nutrition and security etc.

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