Health sector suffers underfunding as maternal deaths rise

By FLAVIA LANYERO

Posted  Saturday, September 14   2013 at  01:00

IN SUMMARY

Crucial items needed by health workers such as antiseptics, surgical blades and gloves missing in government health centres leading to deaths in some instances.

KAMPALA

For Leah Nambirige, life as a midwife is no longer fun. For six months now, she says Mityana Hospital has not had antiseptics, surgical blades, and gloves.

These are crucial items needed by health workers without which child delivery cannot take place. As a result, Ms Nambirige says they have had to turn away several mothers who have not come with these items.

“Some mothers accept and buy these items but others refuse and decide to go to Mulago Hospital. We cannot always chip in and use our money to buy these items,” Ms Nambirige says adding: “Ultimately, this running back and forth of expectant mother to buy these commodities becomes a delay which contributes to a maternal death.”

Ms Sarah Nyombi, a board member of the National Medical Stores (NMS), however, says it is peculiar that the hospital has not had these commodities since NMS delivers only what is requisitioned by hospitals and said the issue would be probed.

But then, the nurses face another challenge. According to Ms Nambirige, nurses are overworked and intimidated by politicians who have come up with a new by-law to cause arrest and prosecution of medics in whose hands a maternal death occurs.

Ms Robina Biteyi, the National Coordinator White Ribbon Alliance for Safe Motherhood, says it is no longer women dying every day due to maternal complications but now 17 mothers and 106 newborns die every day in Uganda partly due to inadequate government investment in life-saving emergency obstetric and newborn care.

Dr Olive Sentumbwe, a family health advisor at the World Health Organisation, says that at the rate at which Uganda is moving, the MDG of 131 deaths per 100,000 live births by 2015 is still unattainable.

Although government’s contribution to the health sector has increased, it hardly matches the growing population needs. This financial year, government allocated only 8.7 percent of the budget to the health sector up from 7.8 percent the previous financial year but this is still below the 15 percent commitment in the 2001 Abuja declaration.

State Minister for Finance in-charge of planning Matia Kasaija, however, says that it is too late to add any money for the health sector this financial year. Mr Kasaija said that although it is possible to increase funds next financial year, governments priority remains infrastructure and electricity.

flanyero@ug.nationmedia.com

Source: http://www.monitor.co.ug/News/National/Health+sector+suffers+underfunding+as+maternal+deaths+rise/-/688334/1991380/-/2jfedp/-/index.html

Give our health sector attention

EDITORIALDaily Monitor Posted  Wednesday, August 14   2013 at  01:00

The unrelenting reports of human resource challenges within the country’s health sector should cause us to pause and consider the health sector situation in order to make practical and progressive steps.

Last week, figures from the Uganda Medical and Dental Practitioners Council showed that more than 2,000 (nearly 50 per cent of the registered number of medical practitioners) had left the country in the past 10 years.

Now the latest report on human resources for health shows that some 1,124 health workers had not reported for duty as of June this year yet they were expected to take over their new offices by the beginning of 2013.

There are clear indications of government’s willingness to deal with these problems and some commendable steps have been taken in that direction. The release of an additional Shs46 billion for recruitment of health workers last year is one of those commendable steps.

Unfortunately, according to the Human Resources for Health report in some districts, there was a notable failure to attract some workers, particularly anaesthetic assistants, ophthalmic clinical officers, public health nurses, dispensers, theatre assistants, cold chain assistants, midwives, and mostly senior medical officers.

Reports from some districts show that the rate of health workers reporting to work after appointment was greatly affected by lack of staff accommodation. Still, for the health workers who reported to work, their retention will be greatly determined by the availability and state of their accommodation, according to the report.

Despite assurances from Health minister Ruhakana Rugunda, that the recruitment exercise was continuous and that other health personnel continue to report for duty as their accommodation issues are being resolved, the government will have to do more in regard to improving the remuneration and working conditions of the health personnel.
Unsustainable stopgap measures will only work to aggravate the current health sector problems.

The government would indeed do well to heed the recommendations of the report, as it calls for partners and all stakeholders to prioritise staff accommodation as a strategy to address the issue of health worker attraction, retention and motivation.

Source: http://www.monitor.co.ug/OpEd/Editorial/Give-our-health-sector-attention/-/689360/1947080/-/3o8y6oz/-/index.html

Kadaga petitioned over maternal deaths

By Umaru Kashaka

Publish Date: Aug 08, 2013

KAMPALA - A coalition of over 40 civil society organizations, united in the fight against preventable maternal and child mortality in Uganda, mid-this week petitioned Speaker Rebecca Kadaga over the crisis of maternal deaths in the country.

Samuel Senfuka presented the petition in the Speaker’s boardroom on behalf of the coalition before holding a vigil of prayer within Parliament for the late Remmie Wamala, a victim of maternal death.

Senfuka, from White Ribbon Alliance, called on Parliament to show its commitment to correcting the crisis through concrete action of increasing investment of sh43.5bn in wages for midwives and other critical cadres.

“We congratulate you for prioritizing health workers in last year's budget through sh49.5bn investment in the recruitment exercise that has deployed thousands of new health workers to health centers IIIs and IVs,” he said.

But he was quick to add: “But Parliament’s work is not done. Without sh43.5bn to enhance pay at local gov’t health facilities, these health workers will simply give up, leading to massive societal and financial waste.”

We must not allow Wamala’s death to be in vain or the thousands of other Ugandan women who, like Wamala, die preventable deaths while giving birth, he pointed out.

Wamala, who was the coordinator of the Uganda parliamentary forum for children, died recently while giving birth at International Hospital Kampala (IHK) of excessive bleeding and a ruptured uterus. 

Her death brought into sharp focus the issue of maternal mortality in the country.

Senfuka said the financial year 2013/2014 budget should prioritize wage enhancement for midwives and other health workers, improve oversight of healthcare, and expand pre-service training for health workers.

“Some of our health facilities are becoming no-go zones for pregnant women and the ultimate responsibility of monitoring them by the health ministry is too weak,” said Mable Kukunda of Uganda National Health Users'/Consumers' Organisation (UNHCO).

The petitioners called on the Legislature to intervene and impose a system of strict oversight so that preventable deaths trigger urgent investigation and action.

“And maternal death audits result in policy change rather than merely reports that sit on shelves,” Kukunda added.

The coalition also called for expansion of pre-service training for health workers in scarce supply, including midwives, lab anesthetists and the public health nurses over the next three years.

This, they reasoned, would enable the health workers offer maternal health services within their health facilities while additional midwives are produced in their training institutions.

Source: http://www.newvision.co.ug/news/645883-kadaga-petitioned-over-maternal-deaths.html

Five Ugandan youth to attend Women Deliver 2013

By Vision Reporter
Publish Date: May 22, 2013

Five Ugandan youth are among 100 youth leaders from all over the world selected to attend Women Deliver 2013, a global conference that will bring together over 5,000 leaders, experts and advocated from 160 countries in Kuala Lumpur, Malaysia next week.

Women Deliver is the decade’s largest global conference focusing on girls’ and women’s health and empowerment.

The conference aims at keeping on the global agenda the issue of investments in girls and women.

Uganda has the largest number of youth leaders from one country. The youths will have the opportunity to learn more about women and girl issues and connect with experts from around the world.

Elman Nsinda, a journalist volunteers at the White Ribbon Alliance to advocate for maternal and newborn health issues. He is one of the delegates.

Nsinda believes that to improve women and children’s health, men need to be tasked to explain when their wives deliver at home and get complications.

“In our community boys don’t understand women issues. I have just started appreciating that what I need, a woman also needs,” he says.

He argues that men in our society are the ones with the economic muscle. “It is their role to save money, to make decisions,” he says.

Orphaned in Primary One, Nsinda was raised by a grandmother. At 17, she too passed away and he was taken on by a paternal aunt.

“I was raised by women and I have seen and understand their challenges,” he explains and this inspires him to work for their cause.

Martin Wanzala, another of the young delegated to Women Deliver believes culture is the biggest impediment to progress in achieving reproductive health.

The team leader at Allied Youth Initiative–Uganda, a youth organization in Mbale has observed that culture envelopes the discussion around sexual and reproductive health issues.

He says young people cannot freely discuss reproductive health issues because of cultural taboos.

“We use drama, music and dance to deliver the message in a gentle way,” he says.

Humphrey Nabimanya, another young leader and founder of Reach A Hand Uganda testifies to the power of the arts in engaging young people for health.

Source:  http://www.newvision.co.ug/news/643037-five-ugandan-youth-to-attend-women-deliver-2013.html

Doctors have decried the poor health-seeking behavior common among Ugandans, saying the practice is not only costing patients a lot of money but is also costing the country lots of lives.

By John Agaba
Publish Date: Feb 27, 2013

Dr. Simon Peter Eyoku, a senior nephrologist [kidney expert] at Mulago Hospital says most Ugandans wait until they are critically ill until they can go to hospital.

“They come when it is already late and they want to be saved. How? But most of these diseases can be prevented or stopped when diagnosis is done early.”

Citing kidney disease, Eyoku says the loss of function usually takes months or years to occur. “So when urine samples tell someone is developing the disease, they can be given medication to support the organ and prevent it from shutting down.”

The kidneys are responsible for cleansing the blood stream.

The medic says people have to learn to test for kidney disease, diabetes, hypertension, cancer, and any other ailments every after five months even if they feel fine, no matter their age.

He explains that patients with mature disease (end-stage renal disease) usually are put on dialysis, “but do you know how expensive the treatment is?”

“At Mulago Hospital, for a week, patients pay sh1m; two weeks it is sh2m. And that is at Mulago, other hospitals charge more than sh2m per week.’’

“Now if you are to spend a year on the machine, how much money is that? And can you afford it?”

He admits that much as medicine has evolved and doctors can carry out transplants, kidney transplants are still not possible in Uganda. The patient has to be flown to India.

“The patient has to first get a kidney donor and then be flown to India. And not everyone is transplantable. At times the body can refuse the other kidney despite the drugs and the patient has to be put back on dialysis.’’

Diabetes and high blood pressure are the commonest causes of kidney disease.

‘Healthy lifestyle’

Earlier, last week, during the health journalists conference at the Kampala Imperial Royale Hotel, medical experts stressed the need for emphasis on preventive health than curative health.

Dr. Fred Okuku, an oncologist and head of the cancer institute at Mulago Hospital urged people to start practicing healthy lifestyles.

He underscored the need for people to involve themselves in physical exercises, to avoid eating fatty and sugary foodstuffs ‘to minimize on some of these non-communicable diseases’.

The doctor said there was lots of illiteracy surrounding the cancer disease yet the disease is growing by the day. And that the numbers of cancer patients at the institute are ever going up and most of them are presented with advanced disease.

“Right now if a patient comes to the institute and his prostate has to be taken out, he is booked for 2014,’’ said Okuku.

He said cancer of the cervix which is caused by the HPV virus was the commonest, closely followed by breast cancer.

Elsewhere, Dr. Olive Ssentumbwe Mugisa, the chairperson of the White Ribbon Alliance Uganda Chapter called on women to try and have pregnancies at the right age – between 20 years and 34 years – to avoid child-birth related complications.

“And don’t get pregnant too frequently,” was her crisp reminder.

“Space and use family planning. Someone has a baby today. But before the baby is off the breast she is already pregnant. This wears the body.”

The maternal mortality ratio in Uganda has changed minimally over the last decade and about 16 women still lose their lives daily. This statistic is coupled with some 45,000 newborns dying every year as a result of pregnancy-related causes.

But about 88% of these maternal deaths can be prevented.

“For nine months someone is pregnant,’’ said Dr. Olive. “During this time they don’t attend antenatal classes and they think they will give birth at home, perhaps with the help of a traditional birth attendant.”

“What happens when they develop complications at the last hour? They don’t have money. The nearest health facility is about 10 kilometers away. They reach the hospital when the baby is already dead. Now what do you want the midwife to do?”

“Both you and me – men and women – have a duty to see that we reduce the numbers of women and children who die because of pregnancy-related complications. (And for) the man, you need to start setting aside some money the moment your wife gets pregnant, and accompany her for antenatal classes.”

Source: http://www.newvision.co.ug/article/fullstory.aspx?story_id=640188&catid=10&mid=53

CSOs Reaction to the FY 2013/14 Budget Speech

Civil Society Coalition to Stop Maternal Mortality in Uganda

Reaction to the Financial Year 2013/14 Budget Speech

For more information contact: Samuel Senfuka, White Ribbon Alliance Uganda: 0704920043

Dennis Odwe, AGHA Uganda: odwedennis@yahoo.com, 0772637740

Nakibuuka Musisi, CEHURD: nakibuukamusisi@gmail.com 0782496681

Asia Russell, Health GAP: asia@healthgap.org, 0776574729

(Kampala) In reaction to the release of the Budget Speech 2013/14 today 13 June, 2013, a coalition of health advocacy organizations released the following statement: “The 2013/14 Budget does not prioritize the most important issues facing Ugandans—it contains massive budget increases for State House and for Defense while health investments that literally mean the difference between life and death for millions of Ugandans have been starved for funding.

‘The economic growth described by President Museveni’s in his June 8 State of the Nation Address is virtually meaningless when communities cannot reliably obtain essential health care in facilities that have the staff, medicines, and equipment needed to save lives,’ said Nakibuuka Musisi of CEHURD.

Furthermore, Government is proposing new regressive taxes in a misguided attempt to fill a revenue gap triggered by aid suspension in the wake of massive theft of donor funding. This policy decision by government will further punish ordinary Ugandans—the victims of theft of public funds—while corrupt officials walk free. ‘Government’s proposed 18% VAT on water is actually a typhoid tax,’ continued Musisi. ‘Corruption already makes us sick—why does government want to punish us further?’

We call on Parliament to stand by their constituents and insist that this Budget is not passed unless and until the following changes are reflected in the 2013/14 Appropriations Bill:

1. Wages for priority health worker cadres must be increased across the health sector, in particular at HC IVs and HCIIIs, in particular midwives, anesthetists, and laboratory technicians. At minimum this will require an investment of Ushs 77.9 billion. Without this investment, the successful recruitment of thousands of new health workers will be in vain—they will be not be motivated to work and will move on to other jobs. Non-financial motivation (staff housing, etc.) for health workers must also be expanded.

2. Dramatically increase the investment in priority medicines, including ARVs and ACTs, recognizing the large unmet need for HIV treatment and anti malaria treatment (including in particular prevention during pregnancy, which will contribute to a reduction in maternal mortality). Government funding for HIV treatment must be scaled up, given the new HIV treatment coverage gap that will be created in 2013 as a result new WHO treatment guidelines, and in order to leverage the fact that Uganda can massively reduce HIV incidence through earlier access to HIV treatment—while saving lives: evidence shows that

Providing treatment for all in need in Uganda would help decrease new HIV infections by 60% and more than 100,000 deaths could be averted over just 4 years.

3. Absorb the costs of an expiring donor grant for paediatric HIV treatment and Early Infant Diagnosis. The total cost for paediatric ARVs and for diagnostics for this grant is Ushs 10.8 billion.

4. Absorb costs required to continue the donor funded, expiring program on Integrated Community Case

Management for malaria.

5. Ensure recruitment of sufficient numbers of staff at General Hospitals and Regional Referral Hospitals

(through second wave of recruitment in remainder of FY 2012-13 and/or through budget for FY 2013-14).

6. Reflect the President’s London Summit Family Planning commitment with increase in additional expenditure for reproductive health commodities by 5 billion shillings each year for 5 years.

‘Uganda lags behind the region and much of the continent in addressing crucial health priorities, from rising HIV incidence, to persistently high rates of maternal death, to preventable deaths from malaria and vaccine preventable illnesses. This is shameful and unacceptable,’ said Dennis Odwe of AGHA Uganda.

‘Uganda cannot be strong economically without tackling these preventable health crises,’ said Samuel Senfuka of White Ribbon Alliance Uganda. ‘Our development suffers when Ugandans cannot gain access to essential health services.’

‘We are well aware that diarrhea diseases are the second leading cause of under five mortality, and an 18% VAT on water is self defeating in achievement of our health goals. Moreover we know that access to safe water is key in the fight against HIV and retention of children in schools,’ said Hellen Kasujja of CIDI. ‘Such a regressive tax will have grave implications, especially on women who are at the epicenter of our economy.’

Civil Society Reaction to State of the Nation Address 2013

Civil Society Reaction to State of the Nation Address

A Coalition of Civil Society Health Experts Respond to President Museveni's State of the Nation Address 2013. 

(Kampala) Today June 6, 2013 a coalition of civil society organizations fighting for realization of the right to health in Uganda issued the following statement in reaction to President Museveni's State of the Nation Address:

"Uganda today is lagging behind the region and much of the continent in addressing crucial health priorities, from rising HIV incidence, to persistently high rates of maternal death, to preventable deaths from malaria and vaccine preventable illnesses. This is unacceptable.
Uganda cannot develop economically as a country without tackling those crises. Our development suffers when Ugandans cannot gain access to essential health services.

Ironically, scientific advances show that right now Uganda could benefit enormously from accelerated investments in the fight against these preventable killers--for example, by aggressively scaling up access to HIV treatment along with other high impact interventions, Uganda could prevent more than 100,000 deaths and slash HIV incidence by up to 60%. By equipping Health Centre IVs and IIIs with the equipment and personnel needed to provide emergency obstetric care, thousands of mothers' and babies lives could be saved.

But today the President gave only superficial mention to these issues in a State of the Nation Address that should have prioritized the fundamental issue of lack of access to quality essential health
services.

For example: today staff in Fort Portal are striking over lack of pay; pregnant mothers are dying without access to safe blood due to lack of supply of testing reagents; nationally, rapid test kits for HIV
detection are almost out of stock; midwives are paid almost nothing working at the frontline to deliver babies--this is disgraceful, and the Financial Year 2013/14 Budget must address fix these problems, or Parliament should not pass it. Furthermore, right now the President is not taking action in response to massive pressure from the EU and US to force Uganda and other least developed countries to accept a deal on generic medicines that would cripple our ability to access affordable treatment.

Unfortunately, we heard nothing in the speech today that indicates the fundamental change needed--genuine prioritization of the health sector through sufficient funding and the political will needed to ensure the sector functions well--bringing essential services to communities most in need, in order to save lives."

State of the Nation Address 2013- http://www.youtube.com/watch?v=Jrti7RTYIss

For more information, contact:

1.    Samuel Senfuka, White Ribbon Alliance Uganda: 0704920043, bsenfuka@gmail.com

2.    Dennis Odwe, AGHA Uganda: 0772637740, odwedennis@gmail.com

3.    Moses Mulumba, CEHURD (Centre for Health, Human Rights and Development) :  0772657974, mulumbam@gmail.com