THE UNSUNG HEROES-MIDWIVES

By Senfuka Samuel
One of the proven strategies to combat Maternal and Newborn Health (MNH) is to have adequate MIDWIVES in Health Centers with the support they require to perform their duties. In 2010 White Ribbon Alliance for Safe Motherhood (WRA Uganda) carried out an assessment of human resources for Maternal Health (MH) in six districts of Uganda and the findings showed gross understaffing of these critical frontline cadres. Even where they are deployed the working environment is not very supportive. It’s on this basis WRA initiated the Teaming up Approach to contribute to addressing the problem.

The Teaming up Approach is a collaborative effort of WRA Global Secretariat team, National team, a team at District level including the Local Government, CSOs, WRA members, Faith based organizations, the media, health workers and MH passionate individuals. Bugiri District found in Eastern Uganda was selected as one of the two districts to implement this approach. After identifying and understanding the problem, the team decided to advocate at District and National levels and push for more midwives, Nurses and Doctors in Health centers III and IV. This needed members to have adequate skills in advocacy and communication hence training.



Teaming Up members at Tabisa’s staff house (the midwife in uniform) sharing on how to improve motivation & retention of health workers.

After a 2day training in advocacy and communication for MH, members visited Nankoma Health Centre IV to have a feel and appreciate the issues we are pushing for. The only Health Centre IV in the District is located 17km from Bugiri main town. The team was led by Dr. Namboozo a Senior Medical Officer at Nankoma and Mr. Opigo Cyrus, Human Resource Manager-Health. We drove through a bumpy murram road and as you enter the facility the first sight is a bushy compound-a breeding hub for mosquitoes! Also a double cabin pick-up ambulance parked near the entrance which looked to have been grounded for some time due to lack of fuel and general maintenance. This delays and negatively affects the referral system.

Dr. Namboozo led us into the maternity ward where we found Tabisa Onyaki a midwife on duty. She looked so stressed and when we asked her how many midwives they are, and how long her working time is, she said that: “we are four midwives but one is on leave, another one went for a training workshop and the other comes in the night shift. So I work from 8.00am to 9.00pm and then my colleague takes over.” This means Tabisa attends to ANC, Maternity ward and delivery alone! At times Tabisa works 24hours and leaves her 3 months old baby under the care of a 12 year old girl.

All Tabisa’s extra time and workload goes without extra pay apart from her meager monthly salary-indeed a hero dedicated to save women’s lives! All this workload excludes her other expected gender roles at home. The only tangible motivation to Tabisa is a two room accommodation with her two kids and water within the facility. However, the house without electricity also needs urgent renovation. This is a snapshot of the staffing situation and the general health system in Bugiri district and Uganda at large.

Tabisa in front of her house, depicting midwifery as a vocational career as  teaming up members look on.

I asked the Human Resource Manager- Health why the district doesn’t identify funds from internal revenues to top up salaries of these unsung heroes than keep lamenting about inadequate funds from the central government. This innovative strategy has worked elsewhere as a way of motivating health workers. The district leadership should have facility visits to appreciate and prioritize maternal health in the district planning and budgeting.

The findings of Human Resource assessment (WRA Uganda 2010) indicate that Bugiri district requires 66 midwives but only 12 were available! This year the district recruited and deployed more five midwives way below the staffing norms by MoH. Bugiri has nine health centre IIIs which are supposed to provide maternal health services but the situation is not any better.

Nankoma HCIV has a theatre which is non operational due to lack of personnel hence no blood transfusion services too. The theatre was instead turned into a male circumcision room under Safe Circumcision programme! This means that if a pregnant woman has a complication that requires an operation (C-Section) or a blood transfusion she has to be referred to the district hospital. Imagine what would happen if there was a delay at home, delayed transport to Nankoma HC IV and a delayed referral exacerbated by non functional ambulance system!

The Teaming Up members shall continue to engage and advocate to the district leadership to appreciate and prioritize maternal health in the planning and budgeting processes. The strategies shall include a pre-district budget lobby meeting with the district leadership to provide adequate resources for core maternal health interventions and dissemination of advocacy messages. The Secretary for Health committed to table a motion before the district council for discussion and adoption of resolutions to address maternal health in the district.

MDG 5 has registered the slowest progress in Uganda as 2015 timeline target is fast approaching. This calls for collaborative efforts at all levels to accelerate the implementation of Uganda’s Road Map to reduce maternal and newborn mortality and morbidity.

A damaged Bugiri -Nankoma road-This can delay transport and also cause accidents

Mrs Margaret Hasasha sharing a light moment with a young expenctant woman in labour

Dr Namboozo (in T-shirt) sharing about the challenges of the health centre

Mr Ali Iwumbwe and Dr Namboozo identified as maternal health champions for Bugiri District

Teaming UP members during a group work at Advocacy and communication training for maternal health

Some members pose for a group photo after the training