Thursday, April 25, 2013

What 8 Women Wish they Knew Before Giving Birth


Posted by WRA Uganda
Ingrid Turinawe, FDC Women League leader, and mother of five children aged between 10 and 19
“No one had ever told me that immediately after birth and the baby cries, the mother becomes so overjoyed and excited. It is something that I got to discover on my own after giving birth to my first born child. In my mind, I was like why didn’t anyone tell me about this awesome feeling. I remember just weeks before going into labour, the mothers that I would chat with would narrate only scary tales about the child birth process. None of them ever told me that soon after birth, a certain overwhelming feeling takes charge of the mother’s body. .”
Harriet Anyango, 38, farmer and mother of two children
“I would be having three children but the second born died just days after delivery. My baby boy was just a few weeks old when he got malaria that claimed his little life. I gave birth to my 15 year old as well as my two year old son naturally but for this second child, it was through caesarean. The pain I felt immediately after the surgery was very agonising. It was even more than the labour pains I had encountered before. I could not sit or stretch any part of my body. In fact I was crying all the time. The pain subsided after about three days. Can you imagine even before going into surgery, no nurse or doctor bothered to tell me what pain to expect immediately after the C-section was done? It was such a traumatising experience for me.”
Betty Nambooze, MP, with 26 adopted children
“I have two children whom I have given birth to naturally. The whole process of giving birth to these two children seemed as if I was battling hard for my life. In other words, it was as if someone was trying to kill me. Can you imagine such a thought! I used to think that it was a matter of going to the labour ward, push the baby and immediately go back home. Honestly, no woman had ever told me about this battle that every expectant mother had to fight as well as win while inside the labour ward.”
Florence Mulindwa, 20, mother of a three month old baby
“I felt the urge of breastfeeding my baby immediately after it was born. However, there was one problem. I had no milk. When I asked the midwife why the milk was not coming from the breasts, she told me that I had not been cleaning my breasts with warm water. This water was meant to remove the so-called “sticks” from the nipples. Once the sticks were off, the milk would flow freely. The midwife told me that it was something I was expected to do right from the early stages of my pregnancy. But since I had not done that before, she told me to wait for a few more days. As I waited anxiously, my breasts were becoming painful. Her advice was very good though I wished someone had told me about it during my early stages of pregnancy.”
Lillian Ajio, 18, mother to a 6 months baby boy 
“I became pregnant while in my Senior Three. I was very young and did not know anything regarding child birth. When the time came for me to deliver, I went to the labour ward totally blank. The midwives were the ones guiding me on what to do most of the time. For instance, they gave me instructions on how to push the baby and how to hold it since it was very tiny. Different mothers had told me before that the midwives would take advantage of my tender age to mistreat me in the labour ward. But they did not do any of that. Those women were very helpful and encouraging. That was something I least expected from them.”
Judith Babirye, Gospel musician and mother of one daughter
“A few years back when I gave birth and immediately started breastfeeding my baby, the experience was quite tormenting. My breasts would pain a lot each time the baby was suckling. Whenever I shared this experience with other women, they would say, I was pretending and yet I was not. But I later got to learn of some other mothers who had gone through the same experience as mine. I just wish someone had at least warned me about such pain once breastfeeding started.”
Pauline Nalubega, 50, mother to a year-old daughter
“When I was going to give birth, the majority of my female friends who had children told me that the pain would only come from the lower part of my body. Little did I know that they were deceiving me? I got the worst headache a human being can ever get when I was pushing my child. At one point, I thought that I was going to die. That headache was just too much. Also, there was a bit of back pain as well, though it was not that bad. If someone had told me earlier that the deadly headaches were part of the deal, I would have been prepared for them.
Suzan Muwonge, rally driver and mother of two
“I had heard of stories of how the whole process of child delivery was very excruciating, I thought that when my turn comes, everything would just be a walk over. But when my turn came, I screamed, shouted and said all sorts of things. I even swore never to get pregnant again. This was especially with my first pregnancy which I had kept a secret from most family members.”

Tuesday, March 12, 2013

Health Centers in Kigezi Sub Region Get a Boost for Safe Motherhood



Installation is already underway
By Nsinda Elman
White Ribbon Alliance Uganda

On 6th March of 2013 Kigezi region saw hope being restored for mothers when the regional populace witnessed the launch of a three year maternal health project code-named  “Saving Lives at Birth (SLAB)”, by three partners including The White Ribbon Alliance for Safe Motherhood- Uganda, African Medical and Research Foundation Uganda (AMREF) and We Care Solar.

Under the Saving Lives at Birth project, 200 health centres in Kabale, Kisoro, Kanungu and Rukungiri districts will be provided with solar power to ensure reliable lighting in maternity wards, delivery rooms and operating theaters.
Speaking during the official launch of the project at White Horse Inn, Kabale Town on Wednesday 6th March 2013, The National Coordinator White Ribbon Alliance Uganda disclosed that the alliance would like to use such an innovation as a research case to find out how it can contribute to motivation of health workers and reduction of maternal and neonatal deaths. She also said that WRA Uganda will ensure that communities are empowered to hold their leaders and maternal health service providers in public facilities accountable and demand what they deserve such as more budget allocations to maternal health.

The AMREF Ag. Project Manager Morish Ojok said that: “the project is aimed at helping midwives who have been struggling with candle light to deliver pregnant mothers, with sufficient light so that they are able to save lives of mothers and their newborns.

 A kerosene lantern used at Bigunjiro Health Centre in Kabale district to provide lighting at the
    facility. It'is one of the facilities to benefit from the solar power installations
 through SLAB project

Kabale District Health Officer, Dr Patrick Tusiime, expressed optimism about the project and described it as a real victory for the region. He however showed concern about the absence of more other supplies and equipment which should be used such as delivery beds, delivery kits and sterilizing equipment.

Among other things to be provided to health centers are laptops to capture maternal and neonatal data as well as facilitating eLearning for midwives and nurses. The solar suit case also comes with an electronic Fetal Doppler for sensing the pulses of the pregnant woman and her feotus, rechargeable headlamps and a provision for charging mobile phones.

An estimated one million mothers living in Kigezi Sub-region are expected to benefit 
from the SLAB project.

Let us act collectively to save our dear women during pregnancy and childbirth.

Friday, February 22, 2013

Government of Uganda Recruits 5,707 Health Workers



On the left is the Ministry of Health team and on the right a section of MPs listening to a presentation by CSOs during a Health Committee meeting at Parliament of Uganda
By WRA Uganda

On Tuesday 19th February 2013, the Ministry of Health team led by Minster of State for Health (General Duties) Hon. Kataike Sarah, Permanent Secretary Dr. Asuman Lukwago and Director General of Health Services Dr. Jane Aceng presented to the Health Committee of Parliament a progress report on recruitment of 10,231 health workers as committed by government in FY 2012/2013. The minster reported that 5,707 health workers had been offered jobs countrywide as of 15th February 2013. In October 2012 during the national budget discussions, the Government of Uganda took a bold decision out of concerted advocacy efforts by Parliamentarians, Civil Society Organizations in health and other stakeholders to recruit 10,231 health workers for HC IVs and IIIs to avert a human resource for health crisis in the country.

According to the ministry report, 36,891 applications were received across the country, shortlisted, interviewed and 7,586 passed the interviews. As of 15th February 2013, the districts had offered 5,707 jobs and 1,533 reported to their duty stations.
The Civil Society Coalition to Stop Maternal Mortality in Uganda and the Coalition for Maternal, Newborn and Child Health on the invitation of the Health Committee also presented their key observations and recommendations that were based on information collected from the District Health Officers and District Service Commissions.

“The Ministry has made some measurable achievements despite the logistic and technical challenges encountered in the recruitment process. This time round the ministry of health has been very committed to ensure at least minimum staffing levels at health centre IVs and IIIs which are nearer to the majority of the people. In the subsequent financial year 2013/14 we ask ministry of health to make it a priority to enhance the wages of lower cadres such as midwives along with further non-financial motivation for medical officers in HCIVs.” Said Senfuka Samuel of WRA Uganda during a presentation to the committee on behalf of CSOs.
According to CSOs information from districts, some districts have failed to attract certain cadres and the ministry agrees with this. For instance Kabale district advertised 12 posts for medical doctors to fill vacancies in their six health centre IVs but managed to recruit only two, Bugiri district advertised 2 posts and failed to attract any. These HC IVs have gone for years without doctors.

A visibly sad Senfuka Samuel add that: “Most HC IVs lack functional operating theatres and lack or have inadequately skilled medical officers, unable to perform Emergency Obstetric Care (EmOC) and newborn care tasks yet a primary objective of establishing HC IVs was to provide facilities for comprehensive EmOC services such as caesarean sections and any other emergency surgery, blood transfusion.”
Senfuka Samuel, WRA Uganda presenting on behalf of CSOs in health a report on health workers recruitment to the Health Committee of Parliament at Parliament as MPs listen.

Ministry of health further highlighted some challenges encountered during the recruitment process some of which will require short term while others long term remedial solutions. For instance failure to attract enough applicants for certain posts e.g. out of the advertised 371 medical officers only 165 were recruited, 1,095 advertised posts for Clinical Officers only 749 were recruited, 1,371 posts for Enrolled Midwives were advertised and 745 were recruited, 449 Anesthetists posts advertised only 51 recruited and 229 posts for Theater assistants but only 54 were recruited. According to MoH some cadres of professional health workers are insufficient in supply because of no more production of such cadres like Theater assistants, anesthetic assistants or few institutions are producing them where as others are due to policy gaps. For instance Uganda stopped producing midwives in 2006 on the premise that the comprehensive nurses could be trained in both nursing and midwifery skills and perform a dual function. However, this has raised continuous debate and resistance from the traditional mainstream midwifery professionals and associations that comprehensive nurses do not have adequate skills and competences to perform midwifery functions hence they were denied an opportunity to apply as midwives in the recruitment drive.

Some districts did not have District Service Commissions in place which delayed the exercise hence reliance on the neighboring District Service Commissions.

Recommendations and way forward 
  • Ministry of Health immediately assesses the number and cause of gaps in the recruitment exercise, per District, and prepare in partnership with District officials remedial action to ensure all 10,231 qualified health workers are identified and deployed as quickly as possible. This should include immediate re-advertising of still-vacant positions and possibly those created as a result of promotions of health workers or crossovers to other districts
  • Ministry of Health should make it a priority in FY 2013/14 to enhance wages of lower cadres of health workers along with further non-financial motivation for medical officers in HCIVs. 
  • Ministry of Education and Sports should closely work with Ministry of Health and partners to draw a training strategy of cadres who are in short supply in addition to scaling up the six month midwifery course for comprehensive nurses in post as one of the remedies
  • Ministry of Health should accelerate the consideration of a policy to recentralize recruitment and deployment of doctors
  • Ministry of health should provide a budget to induct newly recruited health workers
  • Ministry of Health, Parliament, CSOs, media and other stakeholders should ensure that the promise by the Executive/ Ministry of Finance to provide a supplementary budget of Ushs43 billion is not broken, despite financial problems triggered as a result of theft of public funds and subsequent suspension of funding by some development partners
  • Ministry of Health in collaboration with Ministry of Public Service and Ministry of Finance should ensure that any arrears owed to Health Centre IV doctors who were in post by 1st October 2012 are posted on their accounts and all newly hired staff access on the payroll as soon as possible

Monday, January 28, 2013

Accountability for Maternal Health Service Delivery

Senfuka Samuel

Accountability Matters: Ministry of Health through its Uganda Health Systems Strengthening Project committed to deliver the Uganda Minimum Healthcare Package to Ugandans with a focus on #maternal health, #newborn care and #family planning. This was planned to be achieved through improving human resources for health, physical health infrastructure as well as management, leadership and accountability for health service delivery.
The project was to start off by reconstructing and or rehabilitating and fully equip Mubende and Moroto regional referral hospitals, 28 Health centre IVs and 17 District General Hospitals including Bugiri, Iganga, Entebbe, Apac, Pallisa, Nebbi, Kiryandongo, Itojo, Kitgum, Moyo, Anaka, Kawolo, Nakaseke, Buwenge, Bukwo and Mityana District Hospital. This led to a loan request of US $ 130 million from World Bank, which was subsequently approved and passed by the Parliament of Uganda in FY 2010/2011. However, a visit to Mityana General Hospital in central Uganda is a testimony that apart from the foundation stone which was laid about a year now, nothing much has happened! As seen in the photos below, the facility buildings are in a sorry state requiring urgent action. The maternity unit at the hospital was reconstructed in 1995/97 but also requires urgent rehabilitation. 

A call to Parliamentarians to fast track the World Bank loan and the funds so far released to facilitate the works on the targeted facilities.

Bulera Health Centre III Gets a New Maternity Unit and Staff Boost!
Last year, our collective advocacy efforts of civil society organizations in health, Parliamentarians and other stakeholders led to Government's bold decision to recruit and increase the number of health workers at Health Centre IIIs and IVs. A field visit to Bulera HC III (Mityana district) managed by our own WRA Uganda member, Ms Barbara Zzalwango (Health worker representative on WRA Mityana regional committee) has already tested on the benefits by getting additional 4 nurses, 1 midwife, 1 Lab Technician. Congratulations to Ms Barbara who was also promoted to the post of Nursing Officer (Midwifery)! Bulera HC III has also constructed a maternity unit to serve better the increasing population in the catchment area. According to the In-charge, Midwife Barbara, the unit remains only to be equipped with necessary maternity facilities to start operations. 

Do you know a Maama kit, Have you heard about it, Do you know its contents and importance to pregnant women? A visit at Kyamusisi Health Centre III, Mityana District for community engagement in maternal health.


            

A maama kit contains basic items required by a woman at time of delivery/childbirth. It contains gauze, cotton wool, 3 pairs of gloves, a piece of bathing soap and 2 plastic bags-one for delivering on and the other for the newborn. After finding that it was one of the reasons stopping women from delivering from health facilities due to lack of money to buy these items, the Government of Uganda made it a policy for every mother who delivers from the public health facility to get a free maama kit and it was eventually included on the list of essential medicines and supplies that are distributed to health facilities (Health centre III to National Referral Hospital). 

Midwife Oliver Tebakaanya at Kyamusisi HC III, cautioned women and men who turned up for a community feedback meeting on improving maternal health service delivery NOT to accept to be charged for a maama kit at a Government Health facility by any unscrupulous people. 
According to Midwife Sarah Kirabira- In-charge of Kyamusi Health Centre III who is also a WRA Uganda  member and Chairperson of WRA Mityana Regional Committee was happy about the advocacy efforts which has resulted into recruitment and deployment of a Clinical Officer, Lab Technician and an additional midwife.
anticipating to reduce on the workload.

Friday, October 12, 2012

Raising Her Voice to Demand for Improved Maternal Health Service Delivery

Ms Aisha Nalinnya presenting the maternal Health Service delivery status report to leaders on behalf of the community members
By Senfuka Samuel

With its recognized role and contribution to maternal health in Uganda and globally, The White Ribbon Alliance For Safe Motherhood Uganda was chosen by Akina Mama wa Afrika (AMwA) the coordinating agency of Women First Coalition to contribute towards the popularization and domestication of the Maputo Protocol, which was signed and ratified by the Government of Uganda on 22nd July 2010 with reservations on article 14 (1a and c) regarding abortion. 

WRA Uganda focuses specifically on increasing maternal health services as stipulated in article 14:2a and 2b of the protocol.
Article 14: Health and Reproductive Rights  
a)  States Parties shall ensure that the right to health of women, including sexual and reproductive health is respected and promoted.
b)States Parties shall take all appropriate measures to provide adequate, affordable and accessible health services, including information, education and communication programmes to women, especially those in rural areas; establish and strengthen existing prenatal, delivery and postnatal health and nutritional services for women during pregnancy..............

To realize the above, WRA Uganda chose to pilot the initiative in Mityana district working with her regional members, Community members, community and district leaders, area members of Parliament, District Health Team (DHO, Health Center Managers, Health Management Committees, Village Health Teams etc) and private health service providers.

Community members under the guidance of WRA Uganda and WRA members in Mityana district mobilized themselves and carried out an assessment of maternal health services delivery at Kalangaalo Health Centre II, Kyamusisi Health Centre III and Kyantungo Health Centre IV. This was aimed at gathering evidence and information for lobby and advocating to their leaders and service providers as well as taking own responsibility. 


Community members analyzing data after assessment of health facilities












Members analysed the data and the assessment resulted into the following:
1. A maternal health service delivery status report to the District Health Officer and leaders with specific asks.
2. Training of over 30 people in advocacy skills by WRA Uganda who formed Kyamusisi Community Based Advocacy Group to voice out their maternal health needs.
3. Development of Kyamusisi Community Based Maternal Health Advocacy Plan by community members
4. Community members organized a dialogue meeting including community members, community and district leaders, Workers of the Health Centres, Area Member of Parliament. During the dialogue Community members presented their maternal health service delivery status report and agreed to first address the issues of Kyamusisi Health Centre III and thereafter Kalangaalo and Kyantungo Health Centre II and IV respectively.

 Key issues of the maternal health service delivery assessment
§  Out of the ministry of health recommended 19 staff for a Health Centre III, Kyamusisi has only 8 staff.
§  Lack of electricity at Kyamusisi Health Centre. At night midwives deliver mothers using candles or their cell phone torches or mothers are asked to buy kerosene/paraffin for the lump
§  Security. The facility has no security guard making it risky for health workers to receive clients at night. Lack of security resulted into theft of the facility property like the solar panels that had been provided at the opening of the unit.
§  There is no running water in the maternity unit and OPD despite the available water tanks. The two water pumps meant to supply water have been faulty for a long time.


A health worker showing one of the two faulty water pumps



















§ Inadequate and untimely provision of essential medicines which is worsened by the push system at health centre IIs and IIIs. The facilities do not make their own orders based on demand but rather National Medical Stores pushes medicines which are not priority many times.
§ There is no ambulance to transport mothers with complications to Kyantungo HCIV or to the district hospital which are 30km and 45 km away respectively. This is complicated by the poor road to HC IV and district hospital.
§  Lack of resuscitation machine  for infants
§  Non functional Blood Pressure machine
§  Very few mattresses and those available are uncovered
§  Lack of blankets at the unit
§  Only one delivery bed
§  No wheel chair
§  Health workers improvise delivery instruments
§  inadequate infusion stands
§  Lack of sterilizer/Autoclave.  Instruments are boiled using a a charcoal or paraffin stove as shown in the photos below.

The dialogue attracted over 100 participants representing various stakeholders who all acknowledged the urgent need to address and strengthen maternal health services in the district. The DHO reported that annually over 320 women die from preventable pregnancy and childbirth related causes in Mityana district!

Commitments at the Dialogue
§  The DHO gave an assurance of installing solar energy at the facility before end of 2012
§  Hon. Kiwanda SSubi, area Member of Parliament contributed 10 blankets in cash.
§  Two delivery instrument sets were contributed
§  Community members contributed 4 blankets
§  Hon. Kiwanda Ssubi committed to lead a fundraising activity to raise all the essential requirements for the facility before 20th November 2012 by working with WRA Uganda, district and community leaders, DHO and community members.

The next meeting of all stak eholders will convene again to mobilize support for Kyamusisi HC III give feedback to the community. WRA Uganda will continue to work with all stakeholders to bridge the district and national level efforts for improved maternal health and to ensure that health workers are recruited at HC IIIs and IVs as committed by the government in FY 2012/2013. 

Photos speak more than words! WRA Uganda reserves all the rights of the photos. Request for permission at info@wrauganda.org to use them and quote the source.


Members of Kyamusisi Community Based Maternal Health 
Advocacy Group pose for a group photo

Community members at Kyamusisi HC III conducting an assessment of maternal health services


 Kalangaalo Sub-county Chief, Ms Nabaggala did a good job as MC


Community members attending the dialogue

A community member makes his submission during the dialogue

Hon. Kiwandu Ssubi speaking during the dialogue

Dr Kigongo, Acting DHO speaking during the dialogue

A community member handing over the assessment report to Hon. Kiwanda, MP

Ssebuggwawo David of WRA addressing members during the dialogue

From left: LC III Chairperson, Kalangaalo sub-county, Area MP Hon. Kiwanda and the District Health Inspector

Health workers of Kyamusisi HC III led by the In-charge on extreme left speaking to participants at the dialogue

Kalangaalo Sub-county LC III Chairperson responding to issues raised by community members

Hon. Kiwanda appreciates members of Kyamusisi Community Based Maternal Health Advocacy Group for their noble  initiative

Maries Stopes Uganda were one of the services providers at the dialogue-educating 
community members and providing information about family planning services

Hillary Musiima, WRA youth maternal health champion performs safe 
motherhood music which appeals to all individuals to play their part to save mothers!


Dancing to safe motherhood music by Hillary Musiima

Wednesday, October 3, 2012

Government of Uganda Makes a Bold Step to Recruit 6,176 More Health Workers!

 A cross section of parliamentarians and CSOs reps during one of the several budget lobby meetings organized by the Coalition to End Maternal Mortality for additional allocation of money for recruitment of health workers.
By Senfuka Samuel


25th September 2012, - The government of Uganda committed to recruit the recommended number of health workers as per Ministry of Health staffing norms at Health Centre III and IV based and managed at district level across the country. This will be achieved with a provision of additional shs 49.5billion (approx US $19.8 billion) to the health sector.

With this allocation, Government will recruit 19 health workers-all cadres at each Health Centre III and 49 at Health Centre IV in the financial year 2012/2013 with immediate budgetary provision of shs. 6.5 billion (Approx US $2.6 million). The balance of over shs.43 billion will be financed through a supplementary budget after the Minister of Health together with Public Service submit to Ministry of Finance an implementation plan with costs for recruitment within one month of budget passing.

If this is fully met it will increase the health sector budget to about 8% of the national budget. The Government also took action to double the number of Medical Doctors at every Health Centre IV and to increase their salary from shs 1.2 million (Approx US $480) to 2.5M (US $1,000) per month to improve recruitment and retention in rural, hard-to-serve areas across the country.

This assurance  was given by the Rt. Hon Prime Minister who is also the Leader of Government Business in Parliament, Patrick Amama Mbabazi, on the floor of Parliament with immediate provision of shs.3billion (approx US $1.2million) for the recruitment costs and shs.3.5billion (approx $1.4million) for wages of all those recruited.. This follows a stalemate between Parliament and Executive during the budget discussions for the current financial year 2012/2013 with the former demanding additional shs.39.2bn to health sector.

This outcome and move into action by the Executive arm of government did not come on a silver platter but rather concerted and sustained advocacy efforts of WRA Uganda, World Vision, Uganda National Health Consumers Organization and other members of the Coalition to End Maternal Mortality, Members of Parliament regardless of political party line, Health Committee of Parliament, Media, maternal health champions among other stakeholders and ministry of health at the backstage.

Our advocacy campaign was premised on the Human Resource for Health Crisis the country is facing especially at the district healthcare level. The 2012 Human Resources for Health Bi-Annual Report by Ministry of Health shows that the proportion of approved positions filled by health workers at all levels nationally is 58%, with a vacancy rate of 42% and some district hospitals having as low as only 16% filled posts, as well as health workers being poorly motivated and facing very poor working conditions. With a total of 803 Health Centre III government units in the country, they have a staffing gap of 40% with each facility requiring 19 health workers.

This level of healthcare is the first point of maternal health services delivery nearer to the people and essential for the management of safe pregnancies. Similarly, the staffing gap at Health Centre IVs is at 40% with a total of 164 government units nationally. Each sub district health unit requires 49 health workers to effectively offer comprehensive emergency obstetric and newborn care and other services.

In addition, the Uganda demographic health survey results (UDHS 2011) indicate an increase in the maternal mortality ratio at 438/100,000 live births as compared to 435/100,000 in 2006 despite improvement in other maternal and child health indicators. This was not helped by the dwindling share of the health sector budget out of the national budget from approved 8.3% in FY 2011/12 to projected 7.7% in 2012/13!

The above disappointing healthcare situation accelerated our efforts to push for urgent need of more financial investment for recruitment of additional health workers and enhancement of their salaries at a minimum of shs.260 billion (Approx US $104m) to kick start the process.

White Ribbon Alliance Uganda and partners' Advocacy Tactics

§ Budget analysis which generated information for lobbying and influencing reallocation in      the Health Committee of Parliament
§  Lobby meetings for Parliamentarians especially those from the ruling party who are the majority in Parliament to support the additional allocation of Shs 39.2bn as recommended by the budget committee of parliament. Over four lobby meetings were held and MPs committed to support the allocation.
§  Petitioned the Rt. Hon Speaker with specific appeals especially to clearly state the urgent need to find at minimum Shs 260billion in the budget for the recruitment and enhancement of salaries for health workers, encourage and oversee debate on the floor of Parliament regarding the matter rather than restricting the deliberations only to the Budget Committee, to seek clarity from Ministry of Public Service on unjustified ban on recruitment of health workers in the country hindering delivery of maternal health care services, commit to the Health Sector Strategic priorities of allocating at least 8% budget increases to the health sector and recruiting additional 2,000 health workers particularly midwives. Because of its urgency, the Speaker gave the petition a priority and allowed it to be presented to the House during the budget debate before the normal procedure of discussing it first by the relevant committee.
 Presenting the petition to Rt. Hon. Deputy Speaker of Parliament Jacob Olanyah in his 
chambers at Parliamentary Building
§Held numerous press conferences and issued press releases to keep momentum of the public debate as well as continuous feedback and information dissemination

§Produced advocacy and awareness materials targeting parliamentarians and, media to support the budget allocation. This included a video-watch the video at the bottom of this article or click on this link https://www.dropbox.com/s/8j217nrtlllnd9m/Uganda%20Citizens%27%20Voice%2C%20UNGA%20September%202012.mp4 an infographic (sticker) with a message "I support 39.2bn for health workers Now", white ribbons were given for all those especially MPs who were identifying with the additional allocation
§  One-on-one phone calls to MPs was another strategy used for the campaign
§  SMS, emails and social media platforms were used by sending messages requesting MPs to support the allocation as well as mobilizing the general public to take action and ask their MPs to support the additional budget for health.

SMS TO MPs
“Please as our representative DON’T pass the budget without shs 39.2bn to support the health sector. IT’s NOW or NEVER.”

“As a people’s representative DON’T TURN your back on our mothers! DON’T pass the budget without a minimum shs39.2bn for health workers to save lives of Ugandans.”

Results:
·    Appreciation and positive change of attitude by the Executive arm of government to the urgent need for more health workers especially at lower healthcare level which serve majority of the population.
·   Over 1,014 Enrolled Midwives, 1,436 Enrolled Nurses, 758 Nursing Officers (Nurse/Midwife), 223 Medical Doctors, 283 Anesthetists, 1,101 Clinical Officers and 1,360 Laboratory Technicians will be recruited in post at both Health Centre IIIs and IVs accordingly. This is anticipated to reduce on the workload of existing cadres where some have been doing work meant for two or three people yet not commensurate with the pay
·   Unprecedented galvanization of parliamentarians to speak with one voice in saving lives of Ugandans from preventable causes
·   Enhancement of medical doctors’ salary at HC IV. Though our push was to enhance allowances for all cadres to promote equity and gender equality given that most midwives and nurses are women whereas most medical doctors are men!
 Next Steps:
·    WRA Uganda and the Coalition members will convene a reflection meeting  and one of the key focus areas will be monitoring and accountability mechanisms for the funds allocated to the health sector
·   Work with Health Committee of Parliament to ensure that MoH and Public Service expeditiously finalize and submits the implementation plan with costs and the fulfillment of the Executive assurance
· Mobilize and inform WRA members at the district/regional level about the proposed recruitment of health workers at their districts to enable them push for filling the existing vacant posts.

           Hon. Bitekyerezo speaking to the media immediately after a lobby meeting 
           where MPs committed to support additional budget to  address the Human 
           Resources for Health Crisis in Uganda.