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Feature: When a mother bleeds to death, so does the nation

The campaign to drum up more support for maternal and reproductive health in Uganda was boosted when the US and Uganda governments recently signed a letter of intent to work toward stopping maternal mortality at Protea hotel, Kampala.

The US Mission and the ministry of Health are to focus on voluntary family planning, skilled care at birth, as well as emergency obstetric and postpartum care. With 435 maternal deaths for each 100,000 live births, Uganda has one of the highest maternal mortality rates in the world. It doesn’t help matters that only one in four girls have access to contraceptives, and that 50% of all pregnancies are unintended.

Lois Quam, Executive Director of the US government’s Global Health Initiative (GHI), says they want the Ugandan government to take greater ownership and financing of healthcare.

“Investment in health in Uganda is one of the largest we make anywhere else in the world. Government must do more. They must put in more resources. Too many mothers die because they are giving birth to too many children. Far too many women lose their lives,” Quam said.

The US government injects $400m annually to strengthen Uganda’s dilapidated healthcare system. Quam, who was on a six-day visit here in Uganda, toured Mulago hospital as well as health centres in Kabarole and Kyenjojo districts. Both districts have been identified as locations where intensified efforts to decrease maternal mortality could have the most immediate and significant impact.

GHI wants to support the ministry of Health’s effort to reduce maternal deaths by 50% in four western districts – Kabarole and Kyenjojo inclusive – by the end of 2012. If successful, this will provide a model that can be replicated by other districts.

“I heard stories of mothers who did not make it, those who reached health centres and did not find doctors in the health centres. I met midwives who have delivered hundreds of babies with no break,” Quam revealed.

She said hospital administration wants to do more and that they should be helped to overcome these tragedies because many women are dying yet each death is preventable.
In its new approach, instead of focusing on one disease, GHI wants to strengthen healthcare systems because this benefits all mothers and other people. Their support will translate into easy transport to health centres as well as availability of doctors, blood and supplies in hospitals.

“Money must be spent to save lives of mothers because when a mother bleeds to death, a nation bleeds to death,” Quam said.

Health Minister Christine Ondoa reassured the audience, which included the Speaker of Parliament, Rebecca Kadaga and US Ambassador Jerry Lanier, that government recognises the eye-popping maternal mortality, which stands at 435 deaths per 100,000 live births, and infant mortality rate, which stands at 74 deaths per 1,000 live births.

Slow progress

Ondoa acknowledged that Uganda’s progress on Millennium Development Goal (MDG) No.5 to reduce maternal deaths to 131 per 100,000 by 2015 has moved slowly. Uganda’s 2010 MDG progress report states that maternal health indicators for Uganda have generally remained poor in the last two decades. The report notes that over a five-year period, from 1995 to 2001, maternal mortality stagnated at about 505 deaths per 100,000 live births. This was largely blamed on a health budget that was underfunded.

Over the last few years, a number of interventions have been implemented by the Ugandan government in a bid to improve overall maternal and child health. For instance, recently – in 2010 to be precise – a specific funding of $130m over a five-year stretch was allocated to maternal and reproductive health in Uganda’s budget. This money is specifically for improving maternal and reproductive health outcomes as well as constructing health infrastructure.

Of this grand total, $30m is earmarked to cater to reproductive health such as providing contraceptives and family planning services. Though there was a general improvement in health performance in the financial year 2003/04, indicators show that targets were not met. The MDG report notes that Tetanus Toxoid coverage for pregnant women was 50% in 2003/04 against a target of 70%, deliveries in government and private not-for-profit health facilities was 24.4%, falling short of the 2004 target of 30%.

“We have only three years left to get to the target. This partnership comes on board when we need exceptional measures to improve maternal health indicators ahead of the MDG deadline. Government must be in the driving seat and feel that we are in control,” Ondoa noted.

She says government has made maternal health a priority in the national development plan, the NRM manifesto and the subsequent budgets. This financial year, government reallocated Shs 5.4bn to deploy critical staff to health centres. Ondoa says 300 medical staff was deployed in various health centres across the country. She adds that government wants to employ another 800 staff to bridge the gap between the health workers and mothers.

Shs 8bn was also allocated to procure health commodities. In the 2011/12 budget, Finance minister Maria Kiwanuka allocated Shs 26bn to improve services in maternal and reproductive health. It will also embark on an effort to train village health teams, set targets through safe motherhood, and give life initiatives to improve maternal health rates by 50% this year.

Kadaga said Parliament decided to deal with maternal health through the Parliamentary Forum on Maternal Health.

“One item that does not divide the House is maternal health. We debated to increase resources from less important activities to maternal health. We have been asking for a hospital dedicated to women and children,” Kadaga said.


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