Maternal and ne-onatal conditions provide the single highest contribution (20.4%) to Uganda’s total burden of ill health and avoidable death. 435 of every 100,000 women in Uganda die at child birth, national statistics show.
Millennium Development Goal 5 - reducing maternal mortality - therefore is one that Uganda may not achieve by 2015, according to predictions. However, the steady strides being taken to improve the health status of expectant mothers in one small humble village in south-western Uganda shows that moderate interventions like one reliable ambulance and a free delivery kit could turn this trend around as EVELYN MATSAMURA KIAPI writes.
Twenty-nine year old Anastasia Rwomushana is expecting her fourth child. This is her third visit to the health centre since she conceived six months ago. She had abdominal pain. But ordinarily, abdominal pain would not be cause to visit a health centre, especially in a rural setting like Ruhiira, a small village in Isingiro District, south-western Uganda.
Actually, ante-natal checks with a registered nurse are not a priority as a concoction of local herbs prescribed by the traditional birth attendant could do.
But Rwomushana chose the health centre, not only because of the short walking distance from her home, but also that she would get registered to deliver at the Ruhiira Health Centre III when she is due.
That to Rwomushana also means a sense of security because in case of any complications, the stand-by ambulance will rush her to the nearest referral hospital in Mbarara town for emergency obstetrics care – free of charge.
Ruhiira Health Centre III is one of the six units initiated by the Millennium Villages Project (MVP) as part of improving the health status of the locals in Isingiro District. The MVP is an integrated development initiative providing immediate evidence that by empowering communities with basic necessities and adequate resources, people in the poorest regions in Africa can lift themselves out of extreme poverty in five years’ time and thus meet the MDGs by 2015. Ruhiira is one of 12 MVP sites working with nearly 400,000 villagers across Africa.
The MVPs are a brainchild of renowned economist and UN Advisor, Prof. Jeffrey Sachs, and being implemented in partnership with the UN Development Programme, the Millennium Promise, and The Earth Institute, Columbia University.
In Uganda, the project started in 2006 in the sub-counties of Nyakitunda and Kabuyanda, Isingiro District.
These health centres now provide adequate health services by ensuring timely and constant supply of adequate amounts of basic medicines and equipment, thus increasing the utilisation of health care services by the community.
The intervention has since seen the number of out-patient visits increasing from a daily average of 10 by the start of the project to over 100 today, says Dr. John Okorio, Cluster Manager of the project.
“I have benefited a lot from all these facilities at this health unit. Firstly, the unit is near my house, drugs are always available and when somebody has a problem, it is easily solved.
“When I come here with a complication, I get attention, treatment and I am fine. The health centre I used to visit did not have all the services,” Rwomushana says.
Maternal and neonatal conditions provide the single highest contribution (20.4%) to Uganda’s total burden of ill health and avoidable death. Four hundred and thirty-five (435) of every 100,000 women in Uganda die at child birth, statistics show.
The project, therefore, has deliberately prioritised gender equality and improvement in maternal mortality by among other things, enhancing access to essential medical services through increasing community awareness on key health issues. As a result, since its establishment, maternal mortality in the project area has drastically declined.
By the beginning of the project, only 32% of expectant mothers attended antenatal clinics, and only 5% had supervised deliveries, a 2006 baseline survey showed. However, today, the proportion of women attending antenatal care has shot up to 95%, almost doubling the national figure of 47%.
Supervised deliveries also stand at 80% compared to the 41% nationally. The project has also hired well-trained medical staff to ensure safe deliveries in the project area. Approximately 35 major operations are conducted at Kabuyanda Health Centre IV on a monthly basis. The majority of these operations are caesarean sections.
COMMUNITY HEALTH WORKERS
The recruitment and training of Community Health Workers (CHWs) in the project area has greatly improved the health status of the populations. The CHWs are provided with bicycles to ease their movement. Their duty is to monitor household health status, especially expectant mothers and children who they reach out to in their homes and workplaces, offering immunization, education and advice on nutrition, reproductive health and child health.
“These CHW’s also provide mosquito bed nets to all homes free of charge per family. The mosquito nets have reduced malaria in my home,” Rwomushana admits.
Robinah Katusiime, an enrolled midwife at the Health Centre III, testifies that the CHWs have done really well.
“They are the ones going into the villages and encouraging mothers to come to the health centres either to deliver, or for antenatal and postnatal care and advice. They also monitor progress of these mothers,” Katusiime says. More to that, mothers are taught about food safety and the importance of drinking clean water.
FREE MAMA KITS, AMBULANCE
However, Katusiime adds, what has attracted even more expectant mothers to the health centre is the introduction of delivery kits (also known as Mama Kits).
“Initially expectant mothers came here for delivery empty-handed and the local health centres also did not have delivery kits. However, the project has since brought free Mama Kits. So expectant mothers just come in ready to deliver and feel secure,” she says.
The Mama Kits contain items such as polythene paper, soap and a piece of cloth for wrapping the newly born baby. The health centre also offers Prevention of Mother to Child (PMTCT) services, including syrups for the newly-born baby in case the mother is HIV positive. All mothers are tested for HIV during antenatal.
Another significant attraction is the procurement of a fully-equipped ambulance. Previously, it was a hassle for emergency patients referred by Kabuyanda Health Centre IV to Mbarara Regional Referral Hospital, a 60km journey. The road is not only bad; the transport costs are too high for these villagers. But the ambulance has since changed this.
“An expectant mother now comes in here confident that in case of a complication during delivery, the ambulance will immediately take her to a referral hospital.
“They also know that if they stay at home or use the traditional birth attendant and get complications, the ambulance will not go to their village to pick them,” Katusiime says. “This shows us that once the services are available, people are always willing to come to the health centres,” says Dr. Okorio.
Like most rural areas in Uganda, the health situation in Isingiro District has many bottlenecks. There is poor road infrastructure as well as untrained and ill-motivated health personnel, resulting in delays in accessing the necessary medical care. By 2006, malaria prevalence in the project area stood at 18%, while HIV/AIDS prevalence was approximately 8%-10% compared to the national figure of 6.4%.
However, project interventions have seen construction of six clinics to serve a catchment area of 140,000 people in addition to the hiring of well-trained health staff. So far, more than 40,000 insecticide-treated mosquito nets have been distributed to benefit over 70,000 persons, drastically reducing malaria incidences by 40%.
The project has also introduced family planning services at the health centres.
Initially there was scepticism due to cultural beliefs and myths about modern family planning methods. However, because of health education talks, this is changing. This has been achieved with the help of husbands who are increasingly coming in with their partners, which was not the case before.
“But it still remains a challenge,” Katusiime admits. “Men are not that involved. We are trying with the help of the CHWs to get more men on board.”
But the health project is not all about maternal health. Its main objective is to improve access to essential medical services through increasing community awareness on all key health issues, and involving the community in creating awareness and behavioural change to reduce health risks.
The project works through communities, disseminating health information through music, dance and drama, and promoting antenatal care, family planning, immunisation, mass de-worming, as well as voluntary HIV testing and counselling. The project also works to expand health infrastructure by building health units – all equipped with internet connection, recruiting health workers and training CHWs.
The use of mobile phones in data collection is also being piloted. CHWs have been trained to collect patient’s data using mobile phones through COMMCARE, making data collection simpler and quick.