Improve health workers attitude

By Anne Nabukenya

As we countdown to 2015, Uganda is still far from attaining her millennium development goal (MDG) targets relating to the maternal and child health.

Although the 2011 Uganda Demographic and Health Survey report indicates some considerable progress towards reducing child mortality and improving maternal health, these achievements are not sufficient to meet the MDG targets set for 2015. For example, it is unlikely that the current maternal mortality ratio of 438 deaths of mothers for every 100,000 live births can be reduced within the next two years to the set target of 131 deaths.

Despite the government and other stakeholders’ efforts to encourage pregnant mothers to attend at least four antenatal care visits, to deliver and attend postnatal care in health facilities, less than five in every 10 pregnant mothers report for antenatal care on time. Similarly, only six out of the 10 pregnant women who attend antenatal care return to deliver at the health facility.

Antenatal care and deliveries which are not professionally attended to are often associated with complications, which may lead to death of the mother, the baby or both. Furthermore, only three in every 10 mothers access postnatal care, thus, majority miss post delivery services which are aimed at reducing complications and deaths among mothers and their babies. In addition to these, intra-health facility delays are common, where mothers presenting with complications at one health centre are not transferred to another with an expert health-worker in time.

Research into the above mentioned issues have found that the attitudes of some health-workers toward mothers as the main barrier to the health service utilisation and intra-facility delays.

For example, it is reported that health-workers are rude to mothers when they do not have some supplies required at the time of delivery, especially when these items are missing in the facilities (e.g. gloves, basins, etc.). Some studies show that women who do not have these items fear to go to hospitals because they feel health-workers will not treat them well. Such mothers do not have those items not by choice but rather due to poverty and, therefore, should be treated fairly.

Whereas, the health-workers, especially in remote settings are faced with heavy workloads, given the needs and vulnerability of pregnant mothers, health-workers should always have positive attitude towards them. Mothers, who are not well managed, may develop complications and require a lot more care and attention. This in turn exacerbates the workload issues for the health-workers, let alone creates problems for the affected families.  Health-workers should listen to individual concerns and also help mothers plan for and make appropriate arrangements for safe delivery.

 In brief, it is not the lack of skills of the health-workers but the patient-provider relationships that is limiting the quality of maternal health services and their utilisation by mothers. Therefore, this requires action. The government should consider support and motivation for health-workers to ensure an improvement in the attitude towards mothers.  

Efforts to achieve maternal and child health targets should also aim at reducing health-workers’ workload as well as ensuring availability of equipment and supplies, for quality services. Providing quality services to pregnant mothers and their babies will not only save lives but will save money for families and the country in the long run, and is thus an urgent priority.

I appeal to the ministry of health to target the factors that influence the poor attitude of the health workers to boost client provider relationship. This will reduce the maternal and child sufferings and deaths in Uganda.

The writer is a Makerere school of public health CDC Fellow