Friday, February 14, 2014


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

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.