Saturday, August 23, 2014

Marking 500 Days to MDGs Deadline: Citizens Reflect on Accountability Work for Improving Maternal Health

Compiled by Senfuka Samuel with Citizen Journalists Rose Nalugo and  Kaddu William


Kaddu William a Citizen Journalist trained by WRA
Many Civil Society groups do a lot of work but  fail to report back to the stakeholders involved in the initiatives due to weak accountability mechanisms. It's vital to plan and integrate accountability mechanisms in all people-centred initiatives. To be accountable to its stakeholders, White Ribbon Alliance for Safe Motherhood Uganda members in Mityana convened a meeting on 22nd August 2014 to share successes, challenges and lessons learnt from Act Now To Save Mothers campaign implementation. The campaign that was started in October 2013 in the district focuses on pushing Government to fulfill its commitment of providing C-section and blood transfusion services (comprehensive emergency obstetric and newborn care) at health centres IV and basic emergency obstetric and newborn care in all health centres by 2015 . The meeting was attended by district political leaders, District Health Team members, community members, health workers among others.


Sr Esther Kalule speaking to stakeholders at Enro Hotel
Mityana District residents were stricken by sad news of losing ten (10) women in childbirth between January &August 2014. This was revealed by Mityana District Principal Nursing Officer Sr. Esther Kalule at the meeting.  "It's sad to reveal to you that we have lost 10 women between January and August 2014 at the district hospital. Majority of them died due to delays at home, at health centres, poor emergency transport means and by the time they reached hospital they could not be saved." Kalule said. Sr Kalule a midwife called on to White Ribbon Alliance to speed and scale up community social accountability so that linkages among community, health workers and leaders  are strengthened to save lives. "This meeting to give feedback has been an eye opener and a challenge to all of us. I did not know that Government had finally increased our salary and by what percentage but through this feedback meeting am able to get the information," Sr Kalule expressed. According to Sr. Kalule Mityana District Hospital alone delivers an average of 400 women per month of which an average of 100 deliver by cesarean section.



Dr Lwassa making a presentation on district health budget at Enro hotel
Mityana District Health Officer Dr Lwassa in his presentation of the budget for financial year 2014/15 indicated an increment of wages for health workers aimed at motivation & retention. "Our wage bill has increased from shs 3.4 billion in 2013/14 to 5.3 billion in 2014/15. We have also allocated shs 166,000,000 million to improve on staff accommodation which is anticipated to reduce on staff absenteeism." He added


Mr. Bukule presenting on medicines and supplies 2014/15
"We have made great progress since the medicines meeting convened by White Ribbon Alliance in February 2014. We have ensured that life-saving medicines& health supplies are adequately planned for in this FY 2014/15. The remaining challenge is for our In-charges to make timely orders but also National Medical Stores to honor& supply what we request for," District Medicines Management Supervisor. A        budget of Shs 1.2 billion was allocated to the district to procure medicines and health supplies.


Mr. Lubega Israel District Vice Chairperson speaking at stakeholders review meeting
"On behalf of the District leadership, I pledge  our support and continued partnership  with White Ribbon Alliance in improving women's health. We are ready to work together and the community members to ensure that funds allocated to deliver maternal health services are well utilized," District Vice Chairperson committed







GROUP WORK AND DISCUSSIONS IN PHOTOS
Group Discussion led by Chairperson Health Unit Management Committee Naama HC III
Senfuka Samuel giving feedback to stakeholders on national budget proposals 
Group led by Sr Kalule Principal Nursing Officer

Thursday, July 24, 2014

Health rights activists and MPs outline health budget priorities

By MERCY NALUGO

Posted  Thursday, July 24  2014 at  10:37
IN SUMMARY
The total allocation to local governments is Shs323.145 billion compared to Shs575.4 billion reserved for the Ministry of Health headquarters.

Civil society health rights organisations and law makers have identified key areas where they want government to direct more funding ahead of today’s meeting with the ministry of Health aimed at scrutinising budget allocations to the health sector.
In a joint meeting Wednesday, the legislators on the Parliamentary Health Committee concurred with health rights activists of the White Ribbon Alliance (WRA), Initiative for Social and Economic Rights and the Civil Society Budget Advocacy Group (CSBAG) agreed to push for increased funding to the Primary Health Care (PHC), maternal health and enhancing salaries of health workers.
“We as a committee have agreed to prioritise the recruitment of health workers. We shall also demand for answers on allocations to the Primary Health Care and why this area has been marginalised over time,” said the Mbarara Municipality MP, Dr Medard Bitekyerezo, while chairing the meeting.
This was after a submission by members of civil society who stressed that without paying special focus on ensuring an adequate human resource and primary health care funding especially at the various health centres, the health sector would remain crippled which could among others problems, accelerate maternal deaths.
“The dilemma is that government has approved a constant sum of Shs 15billion for Health centre 111s and Health Centres 1Vs countrywide but to us this is peanuts. Most women have died as a result of health workers lacking simple essentials like gloves, fuel for ambulances and lack of electricity as a result of failure to pay exorbitant Bills. Government must direct more funding in this field,” said Ms Robinah Biteyi, the executive director of WRA.
Ms Angella Nabwowe, the Programme Coordinator for Initiative for Social and Economic Rights and a member of CSBAG pointed out that Parliament in 2011 passed a resolution compelling the ministry of Health to submit to Parliament annual reports on maternal audits as a way of curbing maternal deaths and the ministry has never responded to their demand.
She identified the monitoring and evaluation slot in this financial year’s budget arguing that it has remained underfunded.
“The objectives of this according to the Ministerial Policy Statement is to conduct regular health sector performance, monitoring and evaluation, to ensure that standards and guidelines are developed, disseminated and used effectively at all levels. It is also to ensure that a regular support supervision system is established and strengthened at all levels among others”, she said.
In the Ministerial policy statement for the financial year 2014/2015, it is stated that only Shs41 billion  has been allocated as recurrent budget to run health service delivery in 137 local governments with 56 general Hospitals, 61 Private Not For Profit Hospitals and 4,205 lower health units for the last five years.
The total allocation to local governments is Shs323.145 billion compared to Shs575.4 billion reserved for the Ministry of Health headquarters.
“Concentrating resources at the national level is problematic since most people use the public health care system at local government level. Stagnation of this budget line amidst the ever increasing prices of goods and services, including utilities makes the running of health facilities difficult,” Ms Nabwowe said.
PHC budget involves buying hospital equipment that is used on day today activities, clearing the hospital’s electricity and water bills, maintaining the hygiene of the hospital and running ambulances.
While the primary school teachers are getting a 25percent salary increment as announced by the Finance Minister, Ms Maria Kiwanuka in this year’s budget, health workers will benefit from an overall Shs450 billion salary increment for all public servants in the country.
Midwives earn less than Shs350,000 monthly plus a Shs12,000 overtime allowance which the activists said is very little.
The ministry expressed the need to recruit 2400 health workers requiring an additional 23.4billion in wages. But going by the wage bill, the funds were not provided. The Health ministry, however, indicated in the 2014/2015 financial year that it can only recruit through the Health Service Commission an extra 800 health workers for as long as the money is availed.
Source: http://www.monitor.co.ug/News/National/Health-rights-activists-and-MPs-outline-health-budget-priorities/-/688334/2395560/-/item/1/-/gap0erz/-/index.html 

Wednesday, July 16, 2014

Women MPs Want More Funding for Childbirth

By NELSON WESONGA & YASIIN MUGERWA

Posted  Wednesday, July 16  2014 at  01:00
PARLIAMENT. 
Two women representatives want Parliament to push the Executive to allocate more funds to obstetrics – a branch of medicine that deals with childbirth as well as midwifery.
They say the amount the government has been allocating has compromised childbirth so much so that less than 40 per cent of the health centres have piped water in the maternity wards.
“This has compromised clean and safe births, which increases the risk of infections that currently account for about 22 per cent of maternal deaths in the country,” Ms Ronah Rita Ninsiima, the Kabale District Woman Representative, said on Tuesday when reading a petition by women from Kabale.
She added that many health centres could not carry out caesarean sections and transfuse blood.
Relatedly, Ms Joy Atim Ongom, the Woman Representative of Lira District, said the government should meet “new-borns care services”.
The women leader’s pleas – during yesterday’s plenary – come just weeks before the House starts appropriating money for the different government departments, one of which is the Ministry of Health.
Ms Rebecca Kadaga, the Speaker of Parliament, referred the petitions to the House Committee on Health.
The committee should scrutinise the petitions, hear from stakeholders, make recommendations and report back to the House within 45 days.
However, in many cases, many a committee of Parliament do not complete the work within the 45 days.
Consequently, the people who would have rushed to Parliament for assistance assume the House has ignored their problem.
Dr Chris Baryomunsi, the Member of Parliament of Kinkiizi East, said the House should consider whether it should form a special committee to handle petitions.
The Speaker said this could be because some petitions are supposed to be dealt with by some government committees.
editorial@ug.nationmedia.com
Source: http://www.monitor.co.ug/News/National/Women-MPs-want-more-funding-for-childbirth/-/688334/2385158/-/4vslc1z/-/index.html

Friday, March 7, 2014

Equality For Women Is Progress For All: Access To Life Saving Services for Pregnant Women Is A Matter of Fairness and Right

Senfuka Samuel
bsenfuka@gmail.com/info@wrauganda.org

A Book Cover of Becoming A Mother
Traditionally, every 8th March the world celebrates women in recognition of the pivotal role they play in various spheres of development. Women are the mothers of the world, they risk and carry a pregnancy for full nine months and go through the pains of childbirth. Women also nurture us.

Despite the risk associated with pregnancy and the labour pains they go through, pregnancy and childbirth are celebrated around the world. As part of this year's International Women's Day celebration, Ms Brigid McConville-Media Director at White Ribbon Alliance for Safe Motherhood has collected all these wonderful experiences of pregnancy and childbirth around the world including ‪#‎Uganda‬ in a new book ‪#‎BecomingaMother‬A copy of this wonderful book can be ordered at: https://www.oneworld-publications.com/books/brigid-mcconville/on-becoming-a-mother.


In line with UN theme for 2014 IWD "Equality for Women is Progress for All," proceeds from the book (Becoming a Mother) will support the White Ribbon Alliance for Safe Motherhood work towards making pregnancy and childbirth safer for all women regardless of where they live, social or income status.

This year's IWD celebration is aimed at highlighting the importance of achieving equality for women. White Ribbon Alliance for Safe Motherhood Uganda highly considers access to life-saving care services for all pregnant women and newborns as a matter of fairness, a right to healthcare and life.

We call on our government and leaders for more action to accelerate progress towards improving maternal health (MDG5) more especially to ensure that comprehensive emergency obstetric and newborn care (CEmONC) increases in health centres IV from 17% to 50% and that basic emergency obstetric and newborn care services are available in all health centres to avert maternal and neonatal deaths as you promised.

The Time is NOW, the DEADLINE for MDGs is Next Year (2015) #ActNowToSaveMothers

Happy International Women's Day celebrations!


Friday, February 14, 2014

IT IS A DISGRACE: LIRA DISTRICT LOST 6 MOTHERS AND 184 NEWBORNS IN SIX MONTHS!

Sr. Doreen a midwife at Lira Regional Referral Hospital showing a new mother (seated on bed) how to take care of a newborn baby. Photo taken by Senfuka Samuel during a health facility assessment of EmONC at Aromo HC III, October 2013
Senfuka Samuel
WRA Uganda
bsenfuka@gmail.com/info@wrauganda.org


Management of pregnancy and labour is vital for the survival of a pregnant woman and her unborn baby or newborn. This requires a functional health system to meet the needs of both a pregnant woman and the baby. The system should have emergency life-saving medicines; well trained and motivated health workers like midwives, doctors and theater staff; functional theater to conduct caesarean sections and safe blood transfusions; sufficient supplies and necessary equipment among others.

During a meeting on 13th February 2014 convened by White Ribbon Alliance for Safe Motherhood Uganda (WRA Uganda) with Lira district medicines and health supplies procurement and management team headed by the District Health Officer, it was disclosed that in the 1st and 2nd quarter of FY 2013/14, the district officially conducted 5,139 deliveries. However, over the same period of time the district recorded 6 maternal deaths and 184 neonatal deaths of which over 80% were stillbirths (both fresh and macerated)! These deaths go on quietly yet many of them would have been averted if the Government boldly allocated sufficient funds to fulfill its commitment to fully equip Health Centres III and IV with sufficient medicines and supplies for Antenatal Care (focused ANC); Emergency Obstetric and Newborn care (EmONC) medicines and supplies; motivated health workers and the tools they need to provide effective emergency care. 

In October 2013, WRA Uganda together with the District Health Officer (DHO) and his team, leaders and community members conducted a health facility assessment in all the nine (9) government health centres in the district to establish the status of emergency obstetric and newborn care services and the findings correlate well with the maternal and neonatal situation in the district.  As a result and willingness to change the ugly maternal and neonatal situation in Lira, the DHO has made a decision and proposed an allocation of Ushs. 100,000,000 million to renovate the only two theaters at Ogur and Amach HC IVs in FY 2014/2015 so that pregnant women who face obstetric complications can be saved.

To further show his willingness to improve maternal and newborn health, the DHO pledged to prioritize the funds for procurement of equipment in FY 2014/2015 based on the gaps identified during the health facility assessment. This pledge was made during a meeting with district medicines and supplies procurement and management team convened by WRA Uganda and its members in Lira district under “ACT NOW TO SAVE MOTHERS” Campaign. The purpose of the meeting was to discuss the prioritization of essential medicines, supplies and equipment for EmONC in the district procurement plan in FY 2014/2015.

A section of members of Lira district medicines and health supplies procurement and management team chaired by Assistant DHO (MCH) during a group work session (Group One) on developing a procurement plan. Photo taken by Senfuka Samuel during the meeting at Lira district 


According to the WRA Uganda EmONC health facility assessment report only 3 out of 9 health centres had resuscitation devices for the newborns making it difficult for midwives to resuscitate babies with breathing complications at birth. Only 4 out of 9 health centres had blood pressure machines despite the fact that high blood pressure is one of the direct causes of maternal deaths in Uganda contributing about 6%. Only 4 out of 9 health centres had a complete delivery instrument set making management of delivery complicated. In addition all the 9 facilities were found with no running/piped water in their maternity undermining safe and clean births.

According to National Medical Stores an authority mandated to procure and distribute medicines and supplies for all government health centres, Ushs. 3,600,000 and 10,000,000 is allocated to HC IIIs and IVs respectively for medicines and supplies for a period of two months. Districts experience stock-outs of some medicines and supplies partly due to the limited budget in which they operate vis-à-vis the actual demand. This calls for regular review of the budget allocations to reflect the needs and demand from local governments. Ministry of health needs to popularize the newly adopted medicines like misoprostol, chlorhexidine for disinfecting newborn cords etc at the district level health service providers. 


The current maternal and neonatal health situation in Lira gives us a glimpse of what may be happening in other parts of the country. The recently launched Reproductive, Maternal, Newborn and Child Health (RMNCH) Sharpened Plan (2013-2017) by ministry of health in November 2013 identified labor and delivery management as doable evidence based high impact intervention to reduce both maternal and child mortality by averting or saving 4,262 and 13,533 maternal and child deaths respectively over the plan’s time-frame.  This  therefore requires our health centres to be with readily available and accessible basic and comprehensive emergency obstetric and newborn care services to meet such targets. If we are  to walk the talk, ministry of health should therefore request ministry of finance to allocate sufficient funds so that such priorities are reflected in the budget allocations which eventually trickles down to districts for delivery of health services. 
It's equally important that strong accountability mechanisms should exist and put to function to ensure proper utilization of allocated funds.

#ActNowToSaveMothers

Thursday, January 2, 2014

Lira health centres rely on rain water – WRA Study

By Patrick OkinoPublish Date: Dec 22, 2013
Source: http://www.newvision.co.ug/news/650759-lira-health-centres-rely-on-rain-water-study.html

Serious water and power shortages in health facilities present a massive problem in labor wards in Lira district, where birth attendants are forced to use phones and lamps at night during the process of child delivery.

A study by White Ribbon Alliance (WRA), an NGO, found that health facilities rely on water from the wells, boreholes and also rain water.

Among the health centres involved in the survey were Bar, Aromo, Amach, Agali, Ongica, Barapwo and Ober in Lira.

The report revealed that none of the health centres involved in the study had running water, a huge constraint to the flow of activity in the centres.

Absence of piped water therefore means infection control is greatly constrained.

In five out of the nine health centres surveyed, workers reported using personal mobile phone torches as backup for lighting during delivery of mothers at night.

Two birth attendants said they used hurricane lamps and three admitted they had no form of power backup.

The project manager, Senfuka Samuel presented the report to Lira regional referral hospital at the close of this week.

Lira district speaker, Ocen Odyek, LC3 chairpersons, sub-county chiefs, district councilors and health workers attended the presentation of the report.

Six of the health facilities harvest rain water for regular use, seven use boreholes while others rely on wells or hire people to collect water for them, revealed the report.

One midwife from Bar health centre, Betty Akullo said they risk getting infections any time because of shortage of water in the delivery ward.

Acute shortage of water and power at the lower levels is putting more pressure on the referral units.

Senior principal nursing officer at Lira regional referral hospital, Petrua Kiboko says patients are overwhelming referral units in the region because of the problems at the health centres.

The main hospital too runs out of the power sometimes, and has to use generators as backup, with a consumption of about 24 litres per hour.

Friday, December 13, 2013

LIRA COMMUNITY MEMBERS PETITION THE DISTRICT COUNCIL OVER LOW LEVEL OF EMERGENCY HEALTH CARE SERVICES FOR PREGNANT WOMEN

Patrick Ogwang
WRA Uganda (WRA Lira District Media Coordinator)

Tommy Ojan Egits presenting the petition at Amach Sub-county headquarters 
during  Lira District World AIDS  Day commemoration 
White Ribbon alliance Lira in collaboration with residents from the two sub county of Ogur and Amach petitioned Lira District Local Government to allocate a budget in the financial year 2014-2015 to support Emergency obstetric and newborn care services at health center s III and IV. The petition signed by over 1000 community members was presented to the District Council through the District Speaker.
While handing over the petition to the district leaders at the commemoration of World Aids Day district event at Amach sub county headquarter, Tommy Ojan Egit who is a WRA Lira member and newly elected representative at the WRA Uganda board said that the petition followed an assessment by White Ribbon Alliance, leaders and community members carried out in all the health facilities at level of III and IV in Lira with the indicator that none of the two HC IVs is able to provide comprehensive emergency obstetric and newborn care services due to theater functionality issues.
Ojan further stressed that shortage of running water, power and non-functional theaters at Ogur and Amach HC IVs, stock-outs of injectable drugs for basic obstetric complications, inadequate resuscitation devices, lack of blood pressure machines and incomplete delivery instruments among others has put the lives of pregnant women and their newborns at risk since most of them are referred to the main regional referral hospital which is far away from them.
Tommy Ojan Egits handing-over EmONC petition to Lira District 
Vice Chairperson at Amach Sub-county headquarters
“The petition requested the district officials to allocate sufficient funds for emergency care services in the financial year 2014-2015 in an attempt to reduce the death rate of women in childbirth. The White Ribbon Alliance is not an NGO but Alliance whose aims are to advocate for safe motherhood.” Said Tommy

Mr. Andrew Ogwang Oyang the District Vice Chairman and the leader of government while receiving the petition on behalf of the District Speaker and the council thanked The White Ribbon Alliance for their effort of carrying out an assessment saying it has helped a lot the district to get documented information for planning. The Chairperson promised to handle the petition with urgency it deserves so that the issues raised are considered in the district budget.
Subsequently, on 6th December 2013, The White Ribbon Alliance members held a meeting with the members of the district committee for health and education to further advocate for prioritization of emergency obstetric care services in the district budget. Mr. Moses Ogwang Adonyo the Chairperson of health and education committee said that his committee will make sure the report findings are brought to council for further scrutiny and approval so that a budget is allocated in the financial year 2014-2015.

WRA Lira and community members march during World AIDS Day commemoration
event at Amach Sub-county headquarters, Lira 
district before presenting their petition
The petition is part of a series of activities under the accountability campaign code named ACT NOW TO SAVE MOTHERS coordinated by The White Ribbon Alliance Uganda in three districts of Lira, Mityana and Kabale aimed at asking Government of Uganda to uphold its commitment of increasing comprehensive emergency obstetric and newborn care in all health centres IV from 17% to 50% and ensuring that basic  emergency obstetric and newborn care is available in all health centres before its target timeline of 2015. #ActNowToSaveMothers