Monday, November 24, 2014

Public health facilities lack resuscitation devices, newborn deaths high- study

Publish Date: Nov 15, 2014  
Public health facilities lack resuscitation devices, newborn deaths high- study
The commissioner clinical services at the ministry of health, Dr Jacinto Amandua addressing participants during the meeting. PHOTO/Agnes Kyotalengerire

By Agnes Kyotalengerire                     

Majority of public health facilities are lacking basic equipment to resuscitate newly born babies leading to a high number of newborn deaths, a study has revealed.
The report also indicates that in the few health centers where there is equipment, medical workers do not know how to use them.

 “We lose babies who are born tired and cannot breathe because the health facility lacks equipment to resuscitate them,” said Barbara Zalwango a midwife working at Bulera health center III in Mityana district.

Resuscitation devices help to revive babies who fail to breath at birth a condition referred to as asphyxia.

The devices include: an ambu bag (neonatal bag) and mask, suction bulb and a training mannequin.

The study follows a survey that was conducted by White Ribbon Alliance Uganda in three pilot districts of Lira, Mityana and Kabale on the availability of newborn resuscitation devices has shown that most of public health center III and health center IVs lack equipment for resuscitating newborn babies.

Even where the equipment is available, health workers lack the skills to use it.

The national coordinator White Ribbon Alliance for Safe Motherhood Uganda, Robina Biteyi said none of the three districts met the minimum requirements for resuscitation of the newborns which leads to high number of newborn babies dying.

The study findings were revealed  during a stakeholders meeting organized by White Ribbon Alliance for Safe Motherhood Uganda on creating an enabling policy and  implementation framework for procurement , distribution  and availability of newborn resuscitation devices at Golf Course Hotel in Kampala  on Tuesday (yesterday).

 The district health officer Mityana, Dr. Fred Lwasampijja said the cases of newborn death in the district are alarming.

Dr Lwasampijja estimated that in a month about ten newborn babies die due to failure of midwives to resuscitate them when they are born distressed; tired and cannot breathe.

“These are few facility deaths but the number could slightly go up because some babies die at home and the cases are never reported to the health facility,” he said.


Dr. Victaria  Masembe working with WHO (left), the district health officer Mityana, Dr. Fred Lwasampijja(center) and the commissioner clinical services at the ministry of health, Dr Jacinto Amandua during the meeting at Golf Course hotel. PHOTO/ Agnes Kyotalengerire.

Bateyi said procurement of newborn resuscitation devices by ministry of health has been largely dependent on project by donors.

"Health centers cannot order for devices when they need them and mainly have to rely on the ministry of health to buy the devices when there is a funded project," she said 


 What the ministry of health says

The commissioner clinical services at the ministry of health, Dr Jacinto Amandua said with improvement in maternal and newborn health, focus is going to be put on acquisition of maternal and newborn equipment especially for resuscitation and also for helping mothers who have problems during delivery.

“The ministry is going to work with national medical stores to procure equipment for the public health units in addition to supplying medicines,” Amandua said.

He said procuring of resuscitation devices is only one aspect but it is important that every health facility has a skilled midwife to ensure the lives of mothers and newborns are safe.

Newborn mortality in health units is unacceptably high contributing to about 50% of deaths in children under the age of five years.

 According to the study, out of the nine health centers in Lira, only three had newborn resuscitation requirements.

In Mityana, out of 12 health facilities assessed, only 7 had the devices and in Kabale district 19 out of the 22 health centers had the devices.

This situation puts the lives of newborns at risk of death.

According to the Uganda Demographic health survey 2011, a total of 106 newborn babies die every day due to preventable causes.

Of these, 26% die on the first day of life due to failure to breathe and maintain breathing a condition referred to as asphyxia.

President of Uganda private midwives association, Mary Gorret Musoke said the ministry of health should plan with various stake holders to know how much is needed for each health facility, create a budget line for procurement of these devices and train the human resource to use the devices.

 Basic requirements for a labor suit

The president elect, association of gynecologists of Uganda, Dr Jolly Beyeza said a mother in labor should be attended to by two midwives; one extra to give a helping hand in case the baby comes out distressed.

Secondly, there should be a labor bed where a mother labors from, a delivery bed, a delivery kit with all the instruments required for conducting a delivery,  a resuscitation table with all the devices with a light up on the table to keep the baby  warm.

A partograph is also required to monitor the progress of labor, fetal heart.

Monday, November 17, 2014

Citizen Participation in Budget Monitoring and Expenditure Tracking Requires Access To Information

Senfuka Samuel 
info@wrauganda.orgbsenfuka@gmail.com

Mr Keith Meeting WRA team in his office. Photo by Faridah Luyiga
Faridah Mwanje after handling over WRA materials to Mr. Keith
Budget Transparency and Accountability: WRA-Ug meeting with Mr. Keith Muhakanizi Permanent Secretary/Secretary to the Treasury-Ministry of Finance, Planning & Economic Development. The aim of the meeting was to discuss a collaboration for making budget information available and accessible to citizens especially at district level. This is in line with WRA's citizen empowerment approach to monitor and track budget expenditures for Emergency  Obstetric and Newborn Care services at      their health centres.

"Ministry of Finance is happy and ready to partner and work with WRA and CSOs and provide all the necessary budget information. Our goal is to ensure that citizens are aware about their budget so that they are able to hold us accountable on fund releases and expenditures by ministries and districts," Muhakanizi pledges.

Ministry of Finance in the FY 2014/15 identified Budget transparency and accountability as one of the key interventions to strengthen institutional governance, accountability and transparency in public service delivery. Other interventions being undertaken to improve service delivery include:
  • Publication of quarterly fund releases to ministries and Local Governments (both online and print media)
  • Decentralization of the pay roll for civil servants
  • Creation of a Uganda Budget Information Website, meant to enable citizens to access budget information of  resources allocated and utilized up to the local level 
  • The ministry plans to establish an SMS platform and a phone Hotline for public feedback on budget utilization
  • The ministry also conducts quarterly and annual budget monitoring and accountability through its Budget Monitoring and Accountability Unit and at effective implementation of Government programmes and projects.  


All the above are well-intentioned interventions to improve budget accountability and transparency but the question we should all ask ourselves is-how many people (citizens) are aware of these opportunities so that they can effectively participate in their budgets monitoring and expenditure tracking? It is often challenging to the community members to access budget information especially at district and sub-county level under the guise of confidentiality! Citizens need to be empowered to know their rights to access such information but also to use it in executing their obligation of monitoring and tracking utilization of the funds.

Ministry of Finance, Planning and Economic Development should strengthen the budget accountability and transparency by investing in grass-root budget information dissemination and empowerment of citizens with skills to monitor the budgets and tracking expenditures.

#ActNowToSaveMothers #Accountability#Transparency #CitizenParticipation#MaternalHealth #Commit2deliver

URGENT NEED TO REVIEW THE PROCUREMENT AND SUPPLY OF NEWBORN RESUSCITATION DEVICES

Dr Jacinto Amandua Commissioner Clinical Services-Ministry of Health speaking during a stakeholders'
breakfast meeting on newborn resuscitation devices convened by WRA-Ug at Golf Course Hotel, Kampala































MEDIA RELEASE

November 12th 2014
For Immediate Release


(Kampala) In Uganda, 106 newborns die every day due to preventable causes. Of these, 26% die on their first day of life due to failure to breathe and maintain breathing, a condition referred to as birth asphyxia. These deaths can be prevented if resuscitation devices to manage birth asphyxia are available at the health facilities and health workers know how to use them. Basic newborn resuscitation devices include an ambu bag, mask, suction bulb and training mannequin.


The White Ribbon Alliance for Safe Motherhood Uganda conducted health facility  of government-owned heath centers III and IV on the availability of newborn resuscitation devices in three pilot districts; Mityana, Kabale and Lira. WRA Uganda found out that none of the three districts met the minimum requirements for the resuscitation of newborns. Out of 9 health centers assessed in Lira, only 3 had the newborn resuscitation requirements. In Mityana, out of 12 health facilities assessed, only 7 had the devices and in Kabale District, 19 out of 22 health centers had the devices. This puts the lives of newborns at risk of death.


The procurement of newborn resuscitation devices by the Ministry of Health has been largely dependent on projects by donors. Health centers cannot order the devices when they need them and mainly rely on the Ministry of Health to procure the devices when there is a funded project. Without adequate newborn resuscitation services in all districts across the country, newborn survival will continue to be a nightmare.
  
To reduce newborn deaths, the White Ribbon Alliance for Safe Motherhood Uganda recommends the following;

  1. The mandate for procurement of newborn resuscitation devices should be given to National Medical Stores.
  2. Resuscitation devices should be made vital commodities on NMS procurement list so that health centers can order them.
  3.  Ministry of health should create a budget line for procurement of these devices.
  4. Government should allocate more funds for procurement and repair of the equipment.
  5. At least 5% of Primary Health Care funds should be allocated to maintenance of equipment.
  6. There should be regular training for health workers so that they have the necessary skills to use and maintain the resuscitation equipment.


 Notes to editors

Within a minute of birth, a baby who is not breathing should be ventilated with a bag and mask. Although most babies breathe spontaneously at birth, up to 10 percent of newborns require some assistance to begin breathing. Only 3-6% require basic resuscitation, but the correct technique will save 4 out of 5 babies who need it. Every skilled birth attendant should be able to resuscitate a baby who is not breathing.[i]
The White Ribbon Alliance for Safe Motherhood Uganda is advocating for policy change for procurement of newborn resuscitation devices. The advocacy goal is; Ministry of Health (MOH) transfers the procurement of newborn resuscitation devices from its headquarters to National Medical Stores (NMS) in the FY 2015/2016.

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For further information and to arrange interviews, please contact: Faridah Luyiga Mwanje on Tel; 0706835826/0772968685 Email: fluyiga@gmail.com or Elman Nsinda on Tel: 0704182962 Email: nsindae@gmail.com






[i] Save the Children. Surviving the first day: State of the World’s Mothers 2013