Monday, October 27, 2014


Settlements on the hills in Butanda, Rubaya Sub-county, Kabale District

By Senfuka Samuel

“Dear Dr Patrick, we appreciate your effort and all those involved in this process to have the people of Kabale served better. I am okay with the proposed site and I will assume duty early next week. I request if possible help me inform the team in Rubaya Health Centre IV.” Dr Fortunate Asiimwe one of the interviewed medical doctors responded to a job offer by Kabale District Local Government.

“Dr Patrick am ready to serve,” Dr Davis Ahabwe posted to MPARO Health Centre IV committed

The enthusiasm of the newly recruited young doctors brings a ray of hope and smiles to many faces of the people of Kabale especially the women who have been traveling long distances to access comprehensive emergency obstetric care services such as cesarean sections from Kabale Regional Referral Hospital due to lack of doctors at health centre IVs. By all standards Kabale District is a hard-to-reach and hard-to-serve area. It’s over 400 KM away from the capital Kampala and has a rough hilly terrain with relatively poor access roads into the hills where majority of people live. This and other factors make it a big challenge to attract medical doctors and other health worker cadres to work in this part of the country.

Collaborative Efforts and Successes 
In 2013 a citizen led campaign code named Act Now To Save Mothers coordinated by White Ribbon Alliance for Safe Motherhood Uganda (WRA Uganda) was flagged off in Kabale, Lira and Mityana districts. The goal of the campaign is that the Government of Uganda upholds its commitment to ensure that comprehensive emergency obstetric and newborn care increases in health centre IVs from 17% to 50% and that basic emergency obstetric and newborn care services are available in all health centres. The campaign kicked off with a ground breaking participatory health facility assessment in all the three districts to establish the status of Emergency Obstetric and Newborn Care at all Government owned health centre (HC) IIIs and IVs. Twenty two (22) were assessed in Kabale District. The assessment findings showed that Kabale had NO medical doctor in any of its 7 health centre IVs hence none of the health centres could save a pregnant woman with emergency surgery.

Since then Kabale residents have used the findings in engagements with their district and national leaders through dialogue meetings, petitioning District, Petitioning Parliament, citizens’ voice, Videos, budget analysis and advocacy, marches, media among other campaign tactics to change this unacceptable state of health affairs.

The district political and health sector leaders are part of the campaign and they showed a strong level of willingness to do business unusual. They actively participated in health facility assessments and other campaign activities. The District Health Officer (DHO) led efforts to spot and request medical doctors to work in the district. “Despite the many challenges there is a ray of hope, our efforts have indeed started to pay off. I thank our partners for complementing the work of the district under the health sector. In a special way I thank WRA Uganda for dedicating time, resources, advocating and convening stakeholders around maternal and newborn health in the district and at national level. You have helped to refocus our health department priorities and generating ideas for improving maternal and newborn health service delivery,” a visibly happy DHO Dr Patrick Tusiime expressed.

Looking Forward
During a district leaders meeting convened by White Ribbon Alliance for Safe Motherhood Uganda on 17th October 2014 at White Horse Inn, Kabale Dr Patrick Tusiime confirmed that three medical officers had  reported to their stations at Rubaya, Hamurwa and Mparo HC IV respectively. Others will go to Kamwezi, Maziba and Muko HC IVs. “These medical officers are all young people and there is need to be mindful of their personal ambitions and career growth. We have to explore all possible ways to motivate and retain them,” Tusiime cautioned leaders.

Dr Patrick Tusiime-Kabale District Health Officer addressing members 
during a meeting at White Horse Inn, KabalePHOTO BY SENFUKA SAMUEL
In a room filled with majority of District Councilors including the District Speaker, Secretary for Health and Secretary for Finance, the District Health Officer called on them to support and prioritize renovation and construction of staff houses in the planning and budgeting process for FY 2015/2016 which is underway. He added that there is need to continue advocating to central Government to increase financing of district lower health facilities, strengthening community participation and public private partnerships.

“We are currently facing a short supply of anaesthetic personnel on the market but the district has a three prolonged approach to address this gap. A plan is underway with the District Service Commission Chairperson to advertise the vacant posts. We are also discussing with the management of Kabale referral hospital to support the health centre IVs in case we fail to get the staff. The medium term solution will be to identify qualified persons among existing staff and recommend them for training in anaesthesia at Mbarara University and bond them for a specific period of time before they think of working somewhere else,” Dr Tusiime disclosed.

The District Councilors who sit on the district top policy making body (District Council) unanimously agreed to push for a recommendation of top-up allowance for the doctors in the next council meeting slated for November 2014. “Hon colleagues we need to act on this urgently. Llet us take this issue to the council through our Health Committee and District Executive Committee. We shall table a motion for a council resolution to provide a specified amount of top-up allowance for the medical officers and we have all agreed to support it,” District Speaker Hon Twinomuhangi suggested.

The district councilors concurred that motivation is not all about monetary benefits, they agreed to plan with the DHO to visit and meet with the new doctors and old staff at the health centres as a sign of care but also to talk to them about what the district plans to do to improve their working conditions.

A section of District Councilors during the meeting moderated by Mr. Julius Barusya at White Horse Inn-Kabale. PHOTO BY SENFUKA SAMUEL

A journey of a 1000 miles starts with the first step (Chinese Proverb) and Kabale District has made this step. As a minimum, the Government of Uganda must increase funding to fulfill its commitment to fully equip Health Centres III and IV with trained, motivated health workers and the tools they need to provide effective emergency care. And as citizens and other stakeholders we have to keep the momentum as watch dogs to ensure that this commitment is fulfilled.

#ActNowToSaveMothers  #commit2deliver   #MDGMomentum

Saturday, October 18, 2014

Emergency Obstetric & Newborn Care Saved My Wife & Son

Written by Denis Okwir 

A member and a White Ribbon Alliance (WRA) Uganda trained Citizen Journalist in Lira District. Denis is also Coordinator of Youth for Life Uganda, a community based organization. He tracks progress on maternal and newborn health in Lira District. By doing this, he is holding the Government of Uganda accountable to its commitment to improve life-saving care for pregnant women and newborns at health centers III and IV. 

My wife Anna was expecting our first child on October 13th 2014, but delivered a baby boy on August 1st 2014, two months before her due date! She had been diagnosed with Oligohydramnios [a condition in pregnancy characterized by a deficiency of amniotic fluid]. The doctor told us that the fluid which keeps the baby was over due to ‘leaking’ and that any time; the baby was going to come out. Anna was told to go for a diagnostic scan and the report from the ultra-sound showed that the baby was very okay but the fluid around it was little. This was shocking news to Anna and I. Being first time parents; we had no experience and never heard of such a condition. She was told to go for ultra-sound scanning every two weeks. I bought pads for her every day because she was ‘leaking.’ It was quite costly and worrying. This went on for three months, having started when she was five months pregnant. She was told by doctors to go on bed rest with medication.

Anna breast feeding her baby
On August 1st 2014, her condition worsened and doctors recommended emergency surgery to save her life and that of the unborn baby. Anna was operated successfully, giving birth to a premature baby boy. I feared our child would die and had many sleepless nights because it did not breast feed for two days yet its weight was only 1.6 kg. Our son was kept under intensive care for 12 days and this intensive unit has been very instrumental in reducing numbers of babies dying during birth. Our son, Sam Hopeo is a healthy boy and his mother Anna is a healthy loving mother. We are thankful to God and secondly to midwives at Ogur Health Centre IV where my wife first received care and to Dr. Robert, Dr. Sara and consultant Dr. Tiri at Lira Regional Referral Hospital for their tireless efforts to save Anna and the newborn’s life.

As a citizen journalist and an advocate for safe motherhood, I am now more energized to move around villages and communities to encourage pregnant women to attend antenatal care and deliver from health facilities because it helps to identify complications early enough for appropriate and timely care. My wife had been going for antenatal care regularly and this helped us to identify the problem early.

Call to Government: My call to the Government is to support our health centers III and IV with life-saving equipment to help detect and treat complications during pregnancy and birth early so that they can be addressed. Our health workers should be well motivated and equipped with what they need to deliver quality health services.

Advice to my fellow men:  A responsible husband should play his part when the wife is pregnant. I have had a real life experience of the issues (obstetric and newborn complications) we have been advocating for as citizens under White Ribbon Alliance for Safe Motherhood. Together with fellow residents in Lira District under ACT NOW TO SAVE MOTHERS campaign, we have been campaigning to Government to increase Emergency Obstetric and Newborn care services at our health centers III and IV in the district-as a result our district has allocated funds to renovate and equip the operating theaters at Ogur and Amach health centre IVs.  Buying food for women is not enough. Husbands, give your wives all the support they need during pregnancy, childbirth and after birth.

Thursday, October 2, 2014

Development Partners Support the Creation of Global Financing Facility to Advance Women’s and Children’s Health

Posted by Senfuka Samuel

It's your responsibility to ASK your National Leaders (President, Ministers of Health and Finance, MP etc) to commit to ACT and fulfill their promises to improve#maternal and #child health in Uganda. #ActNowToSaveMothers#commit2deliver #MDGMomentum.

Below is a Press Release By The World Bank

New facility sets course to accelerate completion of the Millennium Development Goals and end preventable maternal and child deaths by 2030
NEW YORK, September 25, 2014–The World Bank Group and Governments of Canada, Norway, and the United States announced today that they will jumpstart the creation of an innovative Global Financing Facility (GFF) to mobilize support for developing countries’ plans to accelerate progress on the health-related Millennium Development Goals (MDGs) and bring an end to preventable maternal and child deaths by 2030.
The GFF, in support of Every Woman Every Child, is being developed in close collaboration with a broad range of stakeholders, including partner countries; the H4+ agencies (UNICEF, UNFPA, WHO, UNAIDS, UN Women and the World Bank Group); civil society organizations; bilateral and multilateral development partners; foundations; private sector and others working in the areas of reproductive, maternal, newborn, child and adolescent health. The GFF will support countries in their efforts to mobilize additional domestic and international resources required to scale up and sustain essential health services for women, children and adolescents.
The initial donor commitments to the World Bank Group for the GFF include grants in the amounts of $600 million from Norway and $200 million from Canada. The GFF resources will be provided to countries in conjunction with low-interest loans and grants from the International Development Association (IDA), the World Bank Group’s fund for the poorest countries. Based on strong country demand for health results-based financing programs, these bilateral contributions could leverage up to an estimated $3.2 billion from IDA, for a total of up to $4 billion in financing to support MDG acceleration and improve reproductive, maternal, newborn, child and adolescent health.
The U.S. Agency for International Development (USAID), on behalf of the United States, is committed to working with partners to establish the GFF, bringing its full arsenal of innovative financing mechanisms and public-private partnerships to the collaboration. Aligning USAID's support through these complementary mechanisms could bring upto $400 million in leveraged resources to these efforts.
“The creation of the Global Financing Facility will enable us to transform the business of global health and development with scaled-up, smart, and sustainable financing, so that all women and children have access to lifesaving care,” said World Bank Group President Jim Yong Kim. “This signals our collective resolve as development partners to help countries push further and faster to bring an end to preventable maternal and child deaths and extreme poverty.”
The support to create the GFF was announced by global leaders at the high-level event for Every Woman Every Child during the 69th UN General Assembly. The GFF will be designed to support the goals of the Every Woman Every Child global movement and the Global Strategy for Women’s and Children’s Health, launched by UN Secretary-General Ban Ki-moon during the UN Millennium Development Goals Summit in September 2010, and supported by the G-8 Muskoka Initiative on Maternal, Newborn, and Child Health, launched under the leadership of Canadian Prime Minister Stephen Harper.
UN Secretary-General Ban Ki-moon said, “Under the Every Woman Every Child partnership model, the health community is leading the way in finding innovative solutions and expanding new partnerships. For the first time ever, we have the historic opportunity to end all preventable maternal, newborn and child deaths within a generation. This new funding boost and innovative financing approach will help us get closer to that goal, with United Nations agencies and multiple partners playing a major role.
The GFF will build on the experience, capacity and strong track record of the Health Results Innovative Trust Fund at the World Bank Group to support developing countries’ national plans for scaling up access to quality reproductive, maternal, newborn, child and adolescent health services.  
Prime Minister Erna Solberg of Norway said, Norway is committed to support the Global Financing Facility. With its diversification of resources, results focus and targeting of girls and women, this is tailor- made for the new development agenda.”
 A unique aspect of the GFF is to support developing countries in their transition to long-term sustainable domestic financing as they grow from low- to middle-income economies. The facility is expected to mobilize additional domestic and international funds from a variety of sources, including other bilateral and multilateral donors, domestic budgets, the private sector and innovative financing mechanisms.
A special focus area of the GFF will be to support countries to expand Civil Registration and Vital Statistics (CRVS) efforts toward universal registration of every pregnancy, every birth and every death by 2030. CRVS systems provide a critical accountability tool for reducing mortality and ensuring universal access to health care, education and other essential services. 
Prime Minister Stephen Harper of Canada said, “I am very proud that Canada is a founding member of the Global Financing Facility for Every Woman Every Child. Canada believes that maternal, newborn and child health must stay at the forefront of the post 2015 agenda. Today's announcement will help ensure that developing countries have access to capital that will strengthen their health systems and build the necessary civil registration and vital statistics systems to record and track essential data, which saves the lives of mothers and children.”
Administrator Rajiv Shah, of the United States Agency for International Developmentsaid, “As we set our sights on achieving great human aspirations, we have to reimagine development with new business models, innovations, and partnerships. The Global Financing Facility will harness the creativity and expertise of a range of impressive new partners in order to save the lives of moms and kids everywhere. It is a symbol of a new model of development that increasingly defines how we work around the world to help end extreme poverty."
The MDGs have enabled remarkable shared progress toward ending preventable child and maternal deaths, but the job is not done,” said Ray Chambers, UN Special Envoy for Financing the Health MDGs and for Malaria. “I salute the World Bank, Norway, Canada, and the United States for this visionary and unprecedented collaboration to funding better health, and hope to see impact from this funding in the remaining 462 days of the MDGs.”
Consultations on the design and implementation of the GFF are now underway with countries and with key partners and organizations working on women’s and children’s health. The facility is expected to be fully operational in 2015.
We are delighted with this development,” said Dr. Margaret Chan, Director-General, World Health Organization. “In the last year we have estimated the investment needs for countries to end preventable maternal and child deaths by 2030 (an additional 5 US$ per capita per year in high-burden countries) and also to scale up CRVS plans. We are convinced we can work together so this facility will be the way to channel and leverage efficiently the funding needed to achieve these ambitious but realistic goals.
I welcome this initiative to support and increase national capacity to take leadership on financing women's and children’s health,” said Gra├ža Machel, Chair, The Partnership for Maternal, Newborn & Child Health. “PMNCH looks forward to facilitating wide consultation among its 650+ members from government and development partners, to civil society, academia, health professionals and the private sector to realize this vision.”