BY DARAUS BAHIKIRE
After understanding the fact that in every two minutes, a woman dies somewhere in the world during pregnancy or childbirth and also recognizing Uganda’s fertility rate of 5.4 children per woman, the continued prioritization of maternal health becomes inevitable.
A number of aspects are ascribed to maternal deaths including but not limited to maternal education, delivery age, geographical location, quality of care at the facility, maternal education , arrival time at the facility, accidents, poorly managed deliveries (non-professional) among others.
However, all these factors are overridden by one critical player, Antenatal care (ANC). ANC from a skilled provider is important to closely monitor pregnancy thus reducing the mortality risks for the mother and child. For effectiveness of the visit, every woman is recommended to take least 3 ANC so as to reduce the scourge of maternal mortality.
Uganda’s strength in achieving no or minimal maternal deaths is justified from the existing statistical data which indicate a progressive reduction in maternal deaths over time.
According to the Uganda Health Demographic and Health Survey (UDHS) released by Uganda Bureau of Statistics (UBOS) conducted between June 12 and December 18 of 2016, Uganda registered a drop, though light in the maternal mortality. The 6th study since 1989 noted that the maternal mortality declined from 438 per 100,000 live births to 336 per 100,000 live births, a reduction of more than 100.
The survey results also show that 97 percent of women who gave birth in the 5 years preceding the survey received ANC from a skilled provider at least once for their last birth
The same report indicates that Nearly three-quarters (74%) of live births in the 5 years preceding the survey were delivered by a skilled provider and almost the same proportion (73%) were delivered in a health facility.
We must appreciate that a large proportion of maternal and neonatal deaths occur during the first 48 hours after delivery. Thus, prompt postnatal care (PNC) is important to treat any complications that arise from the delivery, as well as to provide the mother with important information on caring for self-care.
It is indisputable that the government of Uganda has continued to affirm its effort in reducing the lethal area of maternal health in a number of interventions.
The continued decentralization of health services with at least a Health Centre - 111 per Sub -County extends services to our women in the most remote areas which defeats the earlier arrangement of the 80’s when the hospitals in the furthest reach of villages were the only sources of health care. These health facilities, among others services ably conduct deliveries, sensitize and educate visiting mothers in detail, the benefits of undertaking ANC.
These facilities are supported by the VHTs who largely offer health education in addition to offering basic treatment services e.g. malaria, headache and body aches.
The aforementioned levels form referral points to higher level facilities for advanced maternal care: HCIV, General hospitals, Regional referrals and national referral facilities most of which have been renovated, refurbished and re-equipped with functional maternity wards.
Similarly, though still expensive, the New Women and Neonatal Hospital in Mulago is also a great intervention in dealing with the maternal health trap. It seeks to exhaustively deal with terminal maternal cases and also bringing to an end the habit of medical tourism by some Ugandans who intend to seek maternal services abroad.
In the same spirit, we can’t overlook the human resource issue in managing maternal health challenges. In FY 2018/2019, with support from International Development Association (IDA), the Global Financing Facility in Support of Every Woman Every Child (GFF) and the Swedish Government, Uganda’s Ministry of offered scholarships to over 500 Health Workers in key disciplines in Reproductive, Maternal, Neonatal, Child and Adolescent health at Masters, Bachelors, Diplomas and Certificates levels in local institutions.
Conversely, the 2018/2019 salary increment across cadres in the medical field is largely a contributing factor in managing the challenge. For example, an enrolled nurse who earned sh413, 158 and now earns sh613, 158 is able to dedicate, and commit themselves to offer care of desired quality to a mother!
One area that had remained the biggest ‘thorn in the foot’ was lack of country wide emergency services, an issue that has been handled.
On the 21st February 2019, the 'Emergency Medical Services' project was launched by Ministry of Health and Malteser International destined to setting up a functional emergency care system in Uganda. This key initiative will solve the long lasting poor emergency response countrywide, an area that has claimed a big number of mothers, largely due to delayed reach to the health facility.
However, the road to dealing with this phenomenon is marred with challenges of domestic violence, poverty, geographical, hindrances ,illiteracy, laziness of some women, behavioral change, attitude, extortion, child pregnancy ,duty negligence by some health workers ,limited funding of the health sector ,drug theft, corruption among others .
The aforementioned contests therefore point to the fact that, government interventions may not be self-sufficient but rather a cob web of efforts from all stakeholders. Let a mother stick to ANC guidelines and undertake self-care, the father submit to his obligations of supporting a family and health worker commit to their duty and job obligations
In an environment of inestimable challenges, government of Uganda has solemnly depicted itself a combatant in the fight against maternal deaths, the most graded offer every woman ought to be glad with.
Daraus Bahikire is a Communications Assistant at Government Citizen Interaction Centre (GCIC), Ministry of ICT & National Guidance.