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

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