By Moses Odongo
The recently launched State of the World’s Mothers report indicated that Uganda isn’t a safe place yet to be a mother with estimated 16 mothers dying daily due to birth related complications and many more living with debilitating effects for the rest of their lives.
The situation isn’t any better with the newborns with the UDH 2011 estimating that about 106 die every day.
The minister of health, Hon. Ruhakana Rugunda who launched the report reiterated his ministry’s commitment to deliver better maternal, newborn and child related health services and called on every Ugandan to join the fight.
Each year the civil society coalition on Maternal, Newborn and Child Health has conducted assessment of the health sector and selected an issue it persuades government to prioritize with aim of ensuring that citizens are availed the best possible health services within the available national resources.
In 2012 -2013 financial year, the CSOs advocacy efforts secured government to earmark sh. 49.5 billion for human resources for health and the Ministry of Health sought to recruit 10,210 health workers to fill the vacant posts at HC IIIs and IVs. Statistics at Ministry of Health show that a total of 8,079 health workers were recruited and by third quarter of 2013, about 6, 839 had reported to work with just over 5,000 accessing the payroll.
Research conducted by CSOs showed that motivational issues were making most the health workers to quit their posts especially in rural and hard to reach parts of the country – places where they are needed most.
Since 2013, the CSOs have been advocating for government to prioritize Primary Health Care – nonwage component and called on government to double the national budget allocation which was only UGX.41B.
This has got nothing to do with salary but facilitation that helps to ensure that a health worker is at the hospital to save lives.
Water, electricity, fuel, car repair & maintenance, sanitation cost like cleaning the compound and wards, quality of care items, transport, supervision, meetings, administration and support services which enable health centers to effectively and efficiently save lives of mothers and of newborns.
To understand how limited the PHC allocation is; take an example of Budaka health centre IV which using about Sh. 300,000 per month in 2012-13 to pay for electricity /generator fuel to run fridges where vaccines, reagents, ice blocks and blood are stored and to keep the maternity, theatre and OPD all light 24 hrs.
However Budaka only received Sh. 400,000 quarterly in the same period and by close of 2013 it was in debt of 8m of recurrent cost of electricity.
Inadequacy of funds to cover the non-wage recurrent spending has always been an issue for the district health centers.
With the Sh. 41ballocation in 2012-13 as recurrent budget to run health service delivery in 137 local governments with 56 general hospitals, 61 private not for profit hospitals and 4,205 lower level health units, some health facilities have to run on an average budget of Sh. 120,000 per month or Sh. 4000 a day, excluding medicines to deliver the required services. That is far less than what a bodaboda rider spends in a day!
The health committee of parliament has offered listening ear to the CSOs and its chair, Hon. Kenneth Omona being a trained medic, hopefully the CSO’s call for increased allocation towards PHC will be doubled.
Whereas CSOs have done a commendable job, the community needs to be sensitized and empowered to make these calls if the results are to be sustainable. Ultimately the beneficiaries of the advocacy efforts are the communities.
They should be at the forefront of demanding for increased funding towards health as the CSOs play a catalytic role.
CSOs should limit hotel workshops where millions are paid out and prioritize community engagement which should aim to empower citizens to make better health service delivery the battle ground where elections are won or lost.
The engagements should not aim to fill the attendance sheets and provide pictures for reporting to donors but awaken the communities to demand for better quality of service, petition leaders to do more and secure commitments towards saving the lives of the mothers and newborns lost daily.
A demand from communities will ultimately push the political class to towards prioritizing health in the budget process and will deliver better results than a demand from Kampala folks who hardly use health centers.
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