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 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


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