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How community efforts can improve maternal healthcare

If you are the kind of person who never misses television news, chances are that you watched the story of a pregnant woman who was reportedly abandoned by medics at Mukono Health Centre IV, not so long ago.

But in case you missed the story, Ms Patricia Nantume, said to have been experiencing obstructed labour, could not raise the Shs 250,000 wanted by the medical officer on duty before conducting vital emergency surgery.

And going by media reports, this is not the first such case at this very health facility. Similar cases have also been reported in Arua, Mityana, Kayunga, Jinja and Mbale.

While Nantume and her baby were lucky not to have become part of Uganda’s high maternal and neonatal mortality statistics after sympathisers had her rushed to Kawolo hospital using an ambulance which was bought by area MP, Betty Nambooze, many don’t find themselves this fortunate.

Yet again, this episode brought reality right before our eyes that the government cannot provide everything all the time. The media has lately been awash with stories we can draw from, such as those on the shortage of tuberculosis drugs.

One had an anecdote of a patient who had to buy drugs in order not to miss his dose. While these drugs are normally given out free of charge, the government couldn’t provide the medicines in time.

Similarly, in July the media ran a story of how residents of Ruhaama sub-county in Ntungamo district had mobilised money to fund the extension of safe water to their villages after the government failed to respond to their pleas for more than 15 years.

To me, the stories of Nantume’s near-tragic incident, the TB patient who bought his own drugs and the residents of Ruhaama who couldn’t wait for government to fix their water woes, are laden with lessons that can be part of the solution to the unfortunate situation in which many expectant women find themselves during times of urgent need.

Initiatives like Mukono’s, where sympathisers spontaneously pooled financial resources to save a mother in danger remain unstudied, yet they could contribute to the body of evidence needed for policy influence and diffusion purposes.

It would, therefore, be of great importance to have empirical evidence on what the picture would look like if every constituency in this country had a working community ambulance.

What if the many self-help (niigina) groups where members, especially women, make monthly contributions dedicate some of their collections to cater for situations such as the one in which Nantume found herself?

What if the Ntungamo water harambee is adapted for purposes of maternal health? Are there lessons for purposes of improving Maternal and Newborn Healthcare (MNH) that can be learnt from the community?

Well, the Makerere University School of Public Health (MakSPH) is soon leading an implementation research undertaking to test community initiatives for maternal and newborn healthcare. In consultation with the Future Health Systems Research Consortium, Save the Children, ministry of Health, Comic Relief and other MNH key players in the country, MakSPH has designed the Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) project for implementation in partnership with the districts of Kamuli, Pallisa and Kibuku.

Working with communities, health providers, and local government authorities, the study will support community mobilization strategies to increase awareness and uptake of MNH services, promote linkages with financial social networks and local transporters to improve financial and timely transport preparedness.

And going by what I have observed during the MANIFEST consultative process, I am tempted to conclude that community initiatives have a big role in improving and sustaining maternal and newborn health outcomes.

The author is a communication specialist with the Future Health Systems Research Consortium at MakSPH.
akakaire@gmail.com

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