As other people were celebrating Father’s Day on Sunday 16/06/2019, it was a sad note to hear of the death of Monica Namatovu, who passed on while giving birth in Mengo Hospital.
Namatovu, the daughter of former Presidential Press Secretary Mr. Tamale Mirundi, was just one of the 19 women that die everyday out of 100 women that give birth daily. Some of the mothers who die while giving birth we might never know; not because it was their time to die but due to an ill equipped health care system in Uganda.
Namatovu and other Maternal morbidity and mortality cases may happen due to government’s limited and delayed supply of basic maternal drugs, medicine and hospital supplies to the facilities to have a sterile safe delivery and ceaserean section for those mothers that may not have a normal delivery.
In Uganda, government launched a free medical care to all people at all levels in 2006. Unfortunately, many government health centres and hospitals lack enough supply of drugs not only in the labour wards but also in the other departments like accident and emergency, in patient, out patient, ART clinic, laboratory testing kits, reagents and supplies, TB wards if they are there as well as pharmacies or dispensaries.
Maternal mortality could also be due to inadequate staff deployment of midwives, doctors plus other health workers in the health centres and hospitals.
Currently, Uganda’s medical staff deployment is still at only 57 per cent coverage in the health centres which is a risky venture that exposes mothers, children and other patients to death due to limited staff available being exhausted, overworked, a situation that becomes worse when the only available midwife falls sick, or goes on annual / maternity leave leaving either nurses, or nursing assistants or nobody to be in charge of delivery!
So why has the government of Uganda and the district service commissions failed to recruit health workers yet so many nurses, doctors and qualified health workers are rotting on the streets without jobs?!
Poor or delayed pay of the health workers is another cause of maternal deaths. Doctors, mid wives and nurses are one of the categories that are lowly paid in Uganda despite the fragile and critical job they do for this country.
Low pay and delayed pay in turn affects their output. They don’t offer qualitative services to patients, they are frustrated, stressed by the land Lords demanding them rent, absenteeism becomes the order of the day in search for part time jobs to meet basic needs, engage in corruption or charging patients money before treating them, or even selling drugs to meet school fees for their children.
They have tried to engage government to understand their conditions and government has on several occasions promised to increase their salaries in the next financial year, which promises have never been fulfilled!!!
So why can’t government of Uganda get money for salaries of health workers but has money for purchase of tear gas, mambas, guns, military or even keeps on passing supplementary budgets every other year for state house but not health??!!!
Is tear gas more important than the lives of mothers that die in labor every day?
Maternal deaths are sometimes due to limited power supply, equipment and infrastructure. Uganda is where a woman gives birth either in darkness, or on a candle, lantern or a torch of the health worker’s phone. This is coupled with lack of gloves to handle the mother, lack of polythene bags, or even lack of a delivery bed and / delivery mattress.
More to note is the lack of diagnostic equipment like ultra sound Scan that can be used to detect the status of the baby on whether his or her position is fit for normal delivery or early ceaserean section.
How can a country that boasts of being the leading East African supplier of power in the region have mothers deliver in darkness or die in labor in facilities with darkness???
Limited funds allocated to the health sector by government in the national budget is another cause of maternal deaths. Uganda’s government for the last 33 years has not had the health sector top the funds allocation in the national budget. The continuous lack of prioritization of health sector in resource allocation in the national budget is one of the key issues why mothers die in labor.
For example, in the 2019/2020 financial year’s budget, health sector is number seven out the 20 sectors and is not even among the sectors prioritized by government where it was allocated only 2.5 trillion compared to debt repayment that scooped 10.6 trillion, roads and transport that scooped 6.4 trillion, defense &security with 3.6 trillion, education, energy, local government etc.
So is the lack of government prioritization of the health sector due to lack of funds or their priority is how to keep themselves in power??!!!
The lack of continuous medical education and refresher courses for the mid wives, doctors and other health workers may also lead to maternal mortality.
Science and Medical conditions are not static, they keep changing and may require diverse new approaches, medicines or drugs due to the various complications, signs and symptoms. Therefore, health workers that qualified in 1980, 1990, 2000 etc may not manage to handle some cases and therefore need continuous medical education and refresher courses for health workers to keep up to date.
So why should not government sponsor their refresher courses if its not the cause of maternal deaths??!
The continuous lack of supervision and monitoring of health centres and hospitals by the national health monitoring unit and district health inspectors could lead to maternal mortality.
Continuous health inspection of health facilities should be done to ensure that the required medical standards are still met by health workers, sterilization of equipment being done, expired drugs discarded in time, staff performance standards still upheld etc to keep health care standards and keep mothers alive.
Unfortunately, health inspectors spend a quarter or even a year without visiting health centres and hospitals either due to their relaxity, limited budget or limited facilities to use in the inspection. This puts a very high risk on mothers and lives of Ugandans that utilise services from health facilities that do not meet the standards.
As an advocate for SDGs, health is SDG Number three as Good health and Well-being and is one of the (SDGs) Sustainable Development Goals that UN member states including Uganda signed and committed to uphold, protect and implement in their respective countries.
So why don’t we see this commitment exhibited in the budget allocation, planning, programming and implementation.
I therefore, call upon government to prioritize health sector in budget allocation, let us increase staff salaries, let’s increase on drugs supplied in health centres, let us purchase the necessary equipment and supplies required for mothers to deliver safely.
I call upon the Uganda Medical Council to come out and issue a statement on the continuous rampant maternal deaths as well as fight for the rights of health workers to get their salaries paid very well and also paid on time without accepting any threats, intimidation and fear from either government and politicians.
I call upon Parliament of Uganda to stop accepting to pass or approve any national budget for any fiscal year that has not prioritized health or included medical staff salary increment because the patients they treat are not only their voters but could also be their relatives, the mothers that die in labor could also be their children, sisters, cousins and in-laws.
Why should MP’s salaries and allowances be increased by 40% while its a taboo for health workers to demand for salary increment, and when they demand they are told to go and rear goats??!!!!
I call upon government to establish a Salaries Review Board that will continuously review the salaries of all civil servants after every either five or ten years or a specified period of time with an enabling legal framework thereby avoiding discrimination and pressure .
I call upon the health workers to wake up and stand up for their rights and demand for what u rightfully deserve because nobody can make it for u without u being involved directly. Let us also wake up and stop stealing drugs, mal treatment of patients especially the mothers in labor and also uphold and practice the medical ethics and standards.
I call upon government to sponsor and provide refresher courses for the various health workers to get updated information on medicine as well as hospital owners to reduce on maternal deaths.
I call upon the various health workers to do continuous research in various aspects of health to get updated diverse knowledge on medical conditions and issues to reduce maternal mortality.
I call upon human rights activists to come out and team up to fight for the rights if health workers and mothers tthat keep dieing innocently everyday.
I also call upon the women to utilise family planning services and avoid giving birth every year or too many children because our uterus can not be strong enough to accommodate babies every year and the rate of bleeding after birth as well risks our immunity and ability to fight against any infections and diseases thereby being susceptible to maternal deaths.
I also call upon the pregnant women to attend antenatal care in health facilities and hospitals with qualified health workers as a early as possible to get the right care, diagnosis and treatment of your cases because some mothers die due to not attending antenatal care at least four times while pregnant or on a monthly basis while others go to the TBAs (traditional birth attendants) on your village that are not qualified mid wives.
I also call upon the men to be available for the pregnant mothers and attend with them the antenatal care and visiting doctors such that u can both out weigh and understand the condition of the mother and the baby to plan accordingly and reduce on maternal deaths.
I call upon the government of Uganda to operationalize the UNFPA 2030 United Nations Family Planning Agenda 2030 to ensure that we can end preventable maternal deaths, end the unmet need for family planning and have a world in which girls have no limits on their aspirations for the future, no matter where they are born.
Lydiah Namayengo is a Political Analyst, Human Rights & Rule of Law activist, Youth& Women Leadership Mentor
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