Maternal health in Uganda requires urgent attention.

Maternal health in Uganda requires urgent attention.

With barely 3 years to the 2015 MDG target 5 on Improvement of maternal health, Uganda seems quite far from her objective of reducing the ratio of maternal deaths by three quarters and working towards increasing the number of women accessing antenatal services.

Averagely, 16 women die everyday while giving birth which translates to 192 deaths every year. It is noteworthy that most of the pregnancy complications from which these deaths arise are all avoidable with just a few attitude changes and fulfillment of obligations for instance severe bleeding, malaria, health centers without health workers and mid wives mostly due to poor pay, lack of the necessary drugs and equipment therein which are leading factors for pregnant women abandoning health facilities and opting for services of traditional birth attendants who are in most cases not trained and use rudimentary, un-hygienic methods and lack of professional ethics where majority of health workers do not respond to emergency cases unless they have been financially facilitated.

Under Article 33(3) of the Constitution of Uganda, the state undertakes to protect women and their rights, taking into account their unique status and natural maternal functions in society while objective XX of national objectives and directive principles of state policy enjoins the state to use all practical measures and ensure the provision of basic medical services to the population but in spite of these pledges, pregnant women continue to die in Uganda because they cannot afford charges as little as 3,000/=, the health centers, especially in rural areas lack basic equipment and health staff to control severe bleeding or even perform a cesarean section in case of a complication during delivery that might necessitate one, some of these health centers also do not have any source of light and in some cases, candle light is all that is available especially at night for use in the delivery wards.   

Another factor responsible for maternal deaths is the lack of transport means especially ambulances, and for the few cases where these are available, their maintenance  is always hard and as a result, the patients have often been asked to fuel them before use yet in most cases, they cannot afford to. This has presented a challenge for the expectant mothers to access health facilities especially at the time of giving birth. This is because there are few ambulances available, which are sometimes diverted by the health centre in-charges to cater to their private personal needs making it almost impossible for the pregnant women, especially those on referral, to access the much needed attention and thus losing their lives.

It is high time the country works towards improving the conditions of pregnant women countrywide and this involves the contribution of government, health workers and all citizens. There is need for constant civic education on the benefits of attending antenatal visits and for the legislature to come up with a legal framework that clearly targets protection of the rights of pregnant women and spell out punishments for those that fail to adhere to the provisions.

The construction of health centers by the government to provide free health care services to citizens was a welcome move towards improvement of the health sector and fulfillment of its obligations to the citizenry. It is also desirable and recommendable that these health facilities are well equipped with both medical and human resources in order to serve the people better and only then can we move towards achieving the MDGs.

Shortage of Medicines in Ugandan Hospitals & Health Centres

Shortage of Medicines in Hospitals and Health Centres retards Health Care

Despite government’s efforts to improve health service delivery, the facilities still grapple with inadequate and irregular drug supplies or no drugs at all sometimes. This has consequences on the whole health sector and its relevance to the citizens. In 2013/2014 financial year, the government under the health sector will focus on reducing morbidity and mortality from the major causes of ill health and premature death and to reduce the disparities in the provision of health services. To achieve this, a number of interventions have been proposed, some of which include; recruitment of key health personnel to ensure adequate staffing, provision of staff housing for health workers with special attention to under-served areas and all this works hand in hand with the adequate and regular supply of essential drugs in the hospitals and health centres around the country. The Health sector shares proportion of the national budget at 7.4% in the starting 2013/14 FY reducing from 7.8% in 2012/13, which is far below the Abuja declaration target of 15%.

Uganda Debt Network whose niche is in monitoring of Government Programmes to ensure prudent service delivery which is transparent reaching the intended beneficiaries in Uganda, visited some health centres as a sample and got alarming discoveries in relation to lack of or inadequate of drugs in Health centres which makes health service irrelevant to the wanainchi. Monitoring activities were carried out in Mulago Hospital – Kamuli District,  Namwendwa Health Centre (HC) IV, Kinawampere HC II, Kinu HC II, Bubago HC II, Nabilama HC II, Balawoli HC IV, Kasolwe HC II, Namaira HC II and Kibuye HC II. These health facilities had something in common which was lack of essential drugs retarding them to deliver optimally to the people.

In Mulago Hospital, Kamuli Town Council The hospital receives an average number of 400 patients per day from Monday to Friday. However, the delayed delivery of drugs to the hospital makes it hard to have services delivered adequately. The Anti-Retroviral Treatment Department has not received drugs since February although the Department is supposed to receive drugs every quarter. For instance 70 patients who were previously receiving “daption”, a drug that is given to those who are allergic to Septrin have become frustrated and no longer check whether the drug was received by the hospital for distribution apart from about 15 patients who constantly check. Instead the hospital has stocked more malaria drugs yet HIV/Aids prevalence is high in the district. HIV/Aids patients are therefore at risk of developing resistance to ARVs when the drugs are not taken regularly. This worsens their medical condition and response to further treatment.  In Balawoli HC IV in Balawoli Sub County there poor storage of drugs is on the rise. The drug store is too small creating high chances of drugs getting contaminated and turning them poisonous to patients. In Namaira HC II, there has been delayed delivery of drugs too. The HC has not received HIV /Aids prevention drugs, testing kits and other essential drugs like quinine since February 2013. The lack of operational materials/drugs could cause death of patients

It should be noted that inadequate or lack of essential drugs in Health Centres, has eventual consequences one of them being death and constant negligence of medical staff to deliver on their duties. Some health workers are reluctant and yet patients need their quick attention. A young lady of 19yrs (Nakirya Halima) from Butansi Sub County, Naluwoli Parish who had given birth to twins in April 2013 was not attended to and yet she was in a very critical condition. This happened even after Money, Jik and OMO which the medical staff asked for was provided by the care taker (mother – Nabirye). The mother of this lady was advised by other patients in the ward to use a local herb which she applied to save the life of her daughter. After 3days, they left the hospital without proper medical attention. Negligence by medical staff due to lack of drugs can lead to the death of a patient if not discouraged.

Nabirye applying herbs on Nakirya Halima after delivery of twins in Mulago Hospital, Kamuli district in April 2013. Medical staff neglected providing after birth services due to lack of medicine.

It’s the duty of the Districts in question to advocate for timely delivery of drugs by the Ministry of Health to the Health Centres. The district leadership together with the hospital administration should take this as a matter of urgency and set penalties for medical staff who neglect patients at all costs and there should be a reporting mechanism that can be shared with the Ministry of Health to ensure sufficient services are accessible and easily delivered to the intended beneficiaries.

The Government too through Ministry of Health should ensure that there is timely delivery of essential drugs to Health Centres and Hospitals to reduce on the dangers that can come up as a result of insufficient drugs like death, especially in hard to reach areas. Through this, Government will be able to achieve its target for this financial year 2013/14 which focuses on reducing morbidity and mortality.

Young generation should stay away from the Devil - HIV/AIDS

Stay away from the “Devil” himself

When we were growing up, my grandmother used to gather us up every evening while on holiday to narrate stories and ask us how our day had been. Being the only girl in a bunch of male voices, most of the time I would just listen attentively to every single word. And like they say “listening is a virtue” and I learnt a lot. My mother watching from a distance, always made sure that the scripture and Bible stories were part of the package for this would make us grow in the fear of the Lord.

The most captivating story was about the “Devil himself”. Silence was an indication that everyone’s heart beat was racing due to fear the story inspired in us! The devil was described to have sharp long claws, long hands, black as charcoal, red eyes, and scary protruding teeth that will haunt and devour us if we don’t stop doing wrong. When in bed, the dreams of the scary creature would keep emerging and not to be associated to the devil’s child we always tried to do right at all times.

In this age and era, HIV/AIDS is worse than the devil himself. It’s sad that HIV prevalence is taking root in the young generation. Getting back to history, the first HIV/AIDS case was identified in the country along the shores of Lake Victoria in 1982. Superstitions and witchcraft characterized the initial response from communities amidst lack of clear government response to HIV/AIDS. Consequently, the epidemic progressed very fast to all parts of the country initially concentrating in urban and semi-urban centres. In Sub Saharan Africa, where Uganda lies, bears the heaviest burden of the epidemic accounting for 28.5 million children and adults (about 64%) of those living with HIV/AIDS globally while about 97% of the AIDS related deaths in 2005 alone occurred in this region.

As we speak, Uganda has the highest proportion of children orphaned by HIV/AIDS worldwide, and 7.2 percent of Uganda’s population is living with HIV. This amounts to an estimated 1.4 million people, which includes 190,000 children. An estimated 62,000 people died from AIDS in 2011 and 1.1 million children have been orphaned by Uganda's devastating epidemic. HIV prevalence has been rising since its lowest rate of 6.4 percent in 2006. New infections are diagnosed in 150,000 people a year, of whom 20,600 are children. Sadly, almost a quarter of people living with HIV in Uganda are part of the education system - like students. Only 39 percent of young people aged 15 to 24 know all the necessary facts about how HIV can be prevented, suggesting a lack of clear sex education in schools and hence having more HIV prevalence in women/girls at 5.4 percent, compared to 2.4 percent amongst men/boys.

Every minute that passes by, the devil keeps on spreading wings trying to get the young people and deny them a bright future by getting them involved in risky sexual behavior. The increased exposure of youth to pornographic materials has a direct impact of on their sexual behavior.

However, a lot more can be done to stop the long hands of the enemy. Like the fear the devil inspired in us, HIV/AIDS should scare the young people off all channels of the killer disease. There is need for effective Voluntary Counseling and Testing Centers (VCTs) which are not discriminatory not to hinder many young people seeking for counseling, getting tested and accessing treatment (including access to life saving ARVs). Behavioral change communication messages should be emphasized to involve the young people and conceptualize them towards a youth focused environment.

The ABC approach should be repackaged to emphasize “A” for abstinence considering it’s the only sure ticket to a free HIV generation. Comprehensive curriculum expansion of peer education activities including peer counseling, and mainstreaming HIV/AIDS into all youth

Programmes and activities should be considered. Youth-adult relationships need to be built firmly because young people need role models, people they can trust and relate to.

If we are to make significant advancements in the fight against HIV/AIDS in the young generation we must ensure that young people are included at the frontlines of the struggle. It’s time to stay away from the “devil himself”, get tested, know your status and live a healthy life, if positive, get counseling and live a healthy positive life.

The devil – HIV/AIDS is a living reality but together we can avoid it by living our lives responsibly, the future is in our hands as the young generation.