News and Views
Uganda Makes Progress on Maternal Health, But Serious Challenges Remain
KAMPALA, Uganda’s latest Demographic and Health Survey 2011 shows good news; maternal health indicators are improving.
A many as 95% of Ugandan women now receive antenatal care from a skilled provider at least once, 57% deliver babies in a health facility under the supervision of a skilled provider. Furthermore, 33% of the mothers received a postnatal check-up within two days of birth.
While there is some reason to celebrate, senior health officials caution against being complacent, as Uganda is still quite behind in achieving the Millennium Development Goals (MDGs) to reduce infant mortality and increase maternal health.
Health Ministry’s Commissioner Community Health Services, Dr. Anthony Mbonye says that Uganda’s health care services are still far from meeting half of the Millennium Development Goals (MDGs) targets to reduce child mortality and improve maternal health.
“Uganda can clearly not meet MDGs four and five—to reduce by three quarters the maternal mortality rate and to reduce by two thirds the child mortality rate between 1990 and 2015 target of 131 per 100,000, it is yet to meet the 15% budget allocation required by the Abuja Declaration to which Uganda is signatory,” Mbonve said. “With a ratio of 1.8 health workers per 1,000 people, Uganda is also far below the World Health Organization standard of at least 2.5 health workers per 1,000 people.”
Maternal and perinatal health conditions account for over 20% of the total disease burden in the country. The World Bank’s International Development Association is supporting Uganda’s health sector with a US$150 million credit to strengthen health systems in order to deliver the National Minimum Health Care Package to Ugandans. The credit has a specific component that focuses on maternal health, newborn care and family planning.
Dr. Charles Kiggundu, a Senior Consultant Gynecologist at Uganda’s National Referral Hospital, Mulago, said hospitals are registering more deliveries partly because Uganda’s population growth. At independence in 1962, the population was six million, and has ballooned to 34 million today. He is quick to note however, that the number of health facilities has almost remained the same.
“Mulago hospital now records about 110 deliveries in a day, three times much more than what it was intended for,” says Dr. Kiggundu, who has been working at the hospital for 22 years.
There is a lot of overcrowding in hospitals, as typified by the story of Jane Mugendawala who lives in a Kampala suburb about five kilometers from Mulago Hospital. She could not afford to deliver her baby at a nearby private clinic so she opted to go to Mulago where the government provides free services.
One Monday morning, Jane checked into Mulago at 2 am and successfully delivered her baby by 8 am. However, by 3 pm, she was found lying on outside the ward’s verandah because she had to create space for other expectant mothers. She could not be allowed to have decent rest on a bed in the ward.
Dr. Chris Mugerwa, a medical intern on duty at the time explains that the hospital has tried to cope by making modifications to create more ward space but even then some mothers are asked to sleep on the floor or even to share the available mattresses in the maternity ward in order to cope.
“A room that was originally meant for six beds now accommodates 18 beds, which are also not enough for the hundreds of the patients we receive in a day,” he said.
Dr. Mbonye said low government funding is part of the problem.
“Government funds the sector with only 50% of the required budget. The Health sector is supposed to get 15% of the national budget, but only gets seven percent, which translates into US$10 per person instead of the proposed US$40 per person; making it impossible to deliver a comprehensive health package to the citizens.”
A typical health worker is over stretched working about 12 hours and yet the remuneration has not increased to match the hours of service delivery.
“My day starts at 8 am with lectures, service delivery sets in at 10 am, lectures again at 3 pm, back to service delivery from 5 pm to 6.00 when a night shift team is deployed,” said Kiggundu, a medical intern. “I am also expected to read as I have to participate in research, and then prepare for next day’s lectures. This means that I retire from the hospital after 8 pm.”
“Overworked and underpaid, health workers in Uganda have for decades fought hard to persuade the government to improve their working conditions. However, many of them have over the years given up the struggle, opting to join other professions and sectors, or staying in the medical field but giving half-hearted service,” said Dr. Mbonye.
Part of the strategy the Ministry of Health has adopted to cope with the challenges above is to implement the Village Health Team (VHT) strategy, which provides every village in Uganda with the capacity to mobilize individuals and households for better health.
“The VHTs are ordinary people in a society who are trained in the basic health promotion package as well as other add-on modules that meet community health needs,” Mbonve said. “They are playing an important role in mobilizing communities for better health, referral and follow-up. They engage the community to actively take part in improving their own health by preventing ill health and protecting their environment that will impact on health needs in the future.”
According to Dr. Mbonye the VHTs will help Uganda make great strides towards attaining the Millennium Development Goals (MDGs) in health. The country has a maternal mortality ratio of 310 deaths per 100,000 live births and an under-five mortality rate of 56 deaths per 1,000 live births. Despite these challenges, the VHTs have been very instrumental in mobilizing pregnant women to go for antenatal care at nearest health facilities. They explain to expectant mothers the need for antennal care and because of their effort and the rewards are clear as reported by the Demographic and Health Survey 2011. The VHTs are now part of Uganda’s national health strategy.
“Although they have undergone training and have been equipped with adequate knowledge, skills and support to save many lives, they were performing voluntary roles in the community without any facilitation,” Mbonve said. “Hence, they could not replace a functional Health System; they are an adjunct and integral part, and need constant effective support from the health system as well as good remuneration.”