Government is to deploy nine midwives at every Health Center III (HCIII) across the country to reduce work overload and improve care for mothers and babies at birth.  

The Director of Curative Services at the Ministry of Health, Dr. Charles Olaro, says previously at the HCIIIs, there were only two midwives, “now they will be nine midwives, and 17 nurses of different categories,” he says. 

The HCIII serves a population of about 20000 of which 1000 (5%) are pregnant women and on average it delivers 70 mothers per month. 

Maria Hakansson, Her Excellency, the Ambassador of Sweden speaks during the commemoration of International Day of the Midwife held at senior quarters, West Division, on Friday May 05, 2023.

Midwives listen attentively during the commemoration of International Fay of the Midwife held at senior quarters, West Division, Soroti City on Friday May 05, 2023. (All Photos by Shamim Saad)

However, with mostly two midwives working a 24-hour shift for seven days a week, it has been overwhelming. 

Dr. Olaro says to ease the workload and improve care for mothers and babies even at the Health Center IVs, the number has also been increased from three to 18 midwives. 

On Friday May 5, during celebrations to mark the International Day of the Midwives, marked under the theme “Together again: from evidence to reality,” midwives called for the deployment of more midwives in the Ugandan health facilities to reduce the work overload on the few currently deployed. 

Midwives march as they commemorated International Day of the Midwife held at senior quarters, West Division, Soroti City on Friday May 05, 2023.

“Low staffing has caused burnout among midwives, they are not rude but at times, they become impolite,” the Commissioner Nursing and Midwifery, Agnes Chandia revealed. 

The President National midwifery association in Uganda, Annet Evelyne Kanyonyozi, called for equitable distribution of midwives to match their workload. 

“Up to today midwives in Uganda deliver 350 to 500 mothers as opposed to the 175 mothers to be delivered as recommended by World Health Organisation. It’s because of these huge numbers that quality is compromised,” she said. 

Dr Charles Olaro, the Director Health Services, Clinical, Ministry of Health speaks during the commemoration of International day of the Midwife.

Dr Mary Otieno, United Nations Population Fund, (UNFPA) Uganda, Country Representative remarks.

“We pray that in the new restructuring implemented there is more consideration of midwives posted to the lowest health facility.” 

“We as midwives are perturbed by preventable neonatal maternal mortality that prevails due to avoidable and preventable factors such as postpartum hemorrhage that claims 49% of our mothers and pre-eclampsia.” 

Kanyonyozi says the mortalities arise from delays in seeking care, to low uptake of safe motherhood products such as antenatal care, family planning and post-natal care. 

Dr Mary Otieno, United Nations Population Fund, (UNFPA) Uganda, Country Representative remarks.

Hon Anifa Kawooya Bangirana, the State Minister for Heath in Charge of General Duties (purple outfit) joined by midwives dance during the commemoration of International Day of the Midwife.

“As midwives we are determined to ensure that every mother receives respectful maternity care that is cognizant of their rights, for equity and fairness at all times.” 

But she says there is need to deliberately invest in delivery of quality midwifery services by enhancing pre-service and in-service education of midwives. 

Skilling midwives 

Kanyonyozi says more midwives need to be supported to advance their career, and funded to upgrade their education to meet the global standards. 

Peter Pex Paak, Resident City Commissioner (RCC) Soroti City remarks.

Agnes Chandia Baku, the Commissioner in-charge of Nursing and Midwifrey, Ministry of Health remarks.

“We are ready to undertake courses for specialization to meet and avert the challenges that we see. Up to 75% of our clients are lost in our institution and we pray we can have skills to match the complexities that are arising out of the various complications from conditions such pre-eclampsia postpartum hemorrhage,” 

“We cannot do that well unless we are equipped with necessary skills and enabling environment where we have modern technology integrated into the various care aspects,” Kanyonyozi said. 

She says Innovation and technology are at the forefront globally, “We want to see the same effort put in midwifery training in both pre-service and in-service training as well as continuous professional development so that we can ably match the global trends.” 

The Swedish Ambassador to Uganda, Maria Hakansson, said the presence of midwives often makes the difference between life and death for newborn babies and their mothers. 

Hon Anifa Kawooya Bangirana, State Minister for Heath in Charge of General Duties (purple veil), Dr Mary Otieno, United Nations Population Fund, (UNFPA) Uganda, Country Representative (kitengi fabric dress), Maria Hakansson, Her Excellency, the Ambassador of Sweden to Uganda (third right) and midwives tour UNFPA stall during the commemoration of International day of the Midwife that was held at senior quarters, West Division, Soroti City on Friday May 05, 2023. (All Photos by Shamim Saad)

She says investment in midwives is not only investment to save the lives of mothers and newborn babies, “The role of the midwife goes beyond that and lays the ground for individuals and families to plan their lives, enabling them to make informed choices.” 

Hakansson said midwives support and promote healthy families, empowering women and couples to choose whether, when, and how often to have children. 

“Midwives are therefore central for empowerment, and we all know that an empowered woman contributes greatly to economic prosperity, sustainable growth, and development of the nation and, therefore, it is important that women and men have the same power to shape society but mostly their own lives.” 

Hon Anifa Kawooya Bangirana, State Minister for Heath in Charge of General Duties (third left) welcomed upon her arrival by Dr Mary Otieno, United Nations Population Fund, (UNFPA) Uganda, Country Representative (second left), Maria Hakansson, Her Excellency, the Ambassador of Sweden to Uganda (third right), midwives and other dignitaries during the commemoration of International day of the Midwife.

She also said the reduced maternal and child mortality registered by Uganda is a result of the work of midwives, increased number of antenatal visits by mothers, and delivery at health facilities with skilled health workers present. 

She, however, says there were negative consequences from the covid-19 pandemic that challenged some of these positive trends resulting in increased numbers of unwanted pregnancies, teenage pregnancies, unsafe abortions, and limitations in accessing Sexual and Reproductive Health and Rights (SRHR) services and information, especially for young people. 

Midwives from Karamoja region entertain guests.

“Teenage pregnancies reached epidemic proportions in Uganda averaging 32,000 teen pregnancies a month,” she said and teenage pregnancies are responsible for nearly one-fifth of the annual birth in Uganda but also contribute to 20% of infant death and 28% of maternal death. 

Hakansson says improvement to maternal health in Uganda must come with efforts to prevent and reduce Gender Based Violence, child marriages and teenage pregnancies and midwives are the cornerstones in actions taken to fight these challenges. 

She also says for Uganda to achieve the Sustainable Development Goals (SDGs), address teenage pregnancies, and for the midwives to achieve their full potential, government must scale up investment in education, training and deploying more midwives in the health workforce as well as remaining committed to the right to health for all. 

“It’s still very sad to realise that some women are without the support of midwives and health workers when giving birth. 

“Evidence shows it is possible to avert more than 80% of all maternal death stillbirth and neonatal death if midwives are educated according to international standards and if midwifery includes the provision of contraceptives counseling health promotion disease prevention and delivering primary and community care,” Hakansson said. 

Chandia said deploying more midwives will enable them to reach the goal of delivering quality healthcare for mothers and babies. 

St Mary’s Midwifery Training Kalongo act a skit entitled “The African Midwife” during the commemoration of International Day of the Midwife.

Status 

Reports indicate over the years, Uganda has achieved a steady reduction in the maternal mortality ratio, currently standing at 336 deaths per 100,000 live births. 

But the current maternal mortality ratio is still high as compared to the Sustainable Development Goals’ target of 70 deaths per 100,000 live births by 2030. 

According to the 2022 Ministry of Health annual maternal deaths report, Uganda lost 1,226 mothers in health facilities 

“While we take note of the improvements over the years, the death of about 100 mothers per month of those that come to the health facility is still unacceptably high,” the United Nations Population Fund (UNFPA), Country Representative Dr. Mary Otieno said. 

Uganda has an estimated nurses and midwives’ coverage of about 17 midwives per 10,000 people. 

WHO estimates that at least 71 nurses and midwives per 10,000 people are needed to achieve at least 80% of the Universal Health Coverage targets. 

Dr. Otieno says the consequences of not having enough skilled midwives and the required supplies are alarming. “It doesn’t have to be this way,” she says. 

“Evidence shows that universal access to midwives offers the best and most cost-efficient solution to end preventable maternal deaths. By closing the deficit in the number of midwives, we could prevent two thirds of maternal and new-born deaths,” Dr. Otieno said. 

Soroti awards its best Midwives 

Meanwhile, Soroti district has recognized three of their midwives for dedication to duty, service, and outstanding performance. 

Bernadette Epel a retired midwife and mother to Vice President Jessica Alupo was presented with the Florence Nightingale Award by Soroti Regional Referral Hospital, on behalf of the Ministry of Health in recognition of her dedication to duty, service, and outstanding performance. 

Others to be awarded on Friday were Elizabeth Aguti a midwife at Soroti regional referral hospital and Esther Odaga Midwife at Moru- Apesur Health Center III in Soroti.