By Dr. Peter Waiswa
The other day while visiting Sweden a friend of mine told me he has six children; among these was one his family was expecting in four months. I wondered how he could count a pregnancy to be a baby.
In Uganda many women know that they cannot count a pregnancy to be a baby or indeed whether the mother will survive pregnancy because of a weak health care system.
In many Ugandan communities, the pregnancy is called ekintu or a thing, and babies are not named until one month when survival is more assured.
In other words, Ugandans do not trust the system in which women become pregnant, give birth or in which babies are born and nurtured.
As we move to the end of the Millennium Development Goals, we see that Uganda has reduced death of children before five years by about 40% which is commendable.
However, almost one in three of the children who die do so before five years die in the first month of life, the neonatal period, and of these, the majority die on the day of birth.
In Uganda, we lose 69,000 babies per year or about 39,000 deaths and another 30,000 stillbirths. For most of the so called stillbirths, the woman actually starts labour when the baby is alive, but dies during the process because of poor quality health services. In other words, our performance as a country on the care at the time of birth is dismal.
Global newborn specialists recently estimated that at the current rate of reduction in death, it will take an African newborn about 155 years to have the same survival chance as those in the richest countries a century before, yet now we have new interventions. This is unacceptable in the modern era.
Child deaths have reduced for a number of reasons including immunisation, malaria control efforts, and access to care including use of the private sector, improvements in water access and hygiene, and general improvement in the standard of living.
However, most of these interventions cannot help a woman in labour or a newly born sick baby. What they need is high quality care during and immediately after labour, and this should be provided by skilled and motivated health workers working in an environment which can save mothers.
Unfortunately, the current policies and programmes in Uganda prioritise survival of older children and not newborns. For instance, whereas policies allow older children to be treated at all levels including being treated by village health team members and health workers at health centre II; it is the contrary for newborn babies, despite their extreme vulnerability.
The current policy does not allow important drugs, equipment, and skills for newborn babies to be availed at these lower levels of health care, and yet it is these that are most accessible.
Instead, the policy recommends referral for sick newborns to higher levels, something our own research shows does not work.
A sick newborn can die in minutes or a few hours, if quality care is not provided immediately. More so, our Ugandan programmes that are donor driven have in the past two decades prioritised vertical programmes related to malaria and HIV/AIDS and maternal and newborn health was forgotten.
Uganda now has an ambitious “sharpened” reproductive, maternal, newborn and child health plan but its implementation modalities are not clear.
As a country, we must use science to drive policies and programmes. Newborn health constitutes the highest burden of disease, and must receive the policy, programme, funding and advocacy response it needs.
The writer is a lecturer at Makerere University and a Post-Doctoral Fellow at Karolinska Institute, Sweden.