A piece of paper that saves a mother’s life
Jul 07, 2010
IN the maternity ward of Nkondo Health Centre III in Buyende district, Rose Nabirye, 21, smiles at the newborn baby resting on her chest. As she recalls how, a few weeks ago, her baby stared death in the face, she is overwhelmed by relief that they are both alive.
By Frederick Womakuyu
IN the maternity ward of Nkondo Health Centre III in Buyende district, Rose Nabirye, 21, smiles at the newborn baby resting on her chest. As she recalls how, a few weeks ago, her baby stared death in the face, she is overwhelmed by relief that they are both alive.
For two days, Nabirye was in labour at her village in Ndulya, a village in eastern Uganda as she could not get to a health centre for lack of transport.
Luck smiles
Then luck smiled at her: a relative called Nkondo Health Centre III for support and a motorcycle was sent to pick her up.
Within just 20 minutes, Nabirye was at the centre in the hands of a health worker.
“It was a painful delivery but worth the effort; I would have died if I had insisted on delivering under the care of a traditional birth attendant,†she explains.
The mother of three adds that in the past, she lost a baby during birth because she chose to deliver under the care of a traditional birth attendant. The health centre was far and she had no money for transport.
This time, Nabirye gave the motorcycle rider a coupon worth 2,000 as transport fare and the rider presented it to the health centre workers and he was paid the sh2,000 cash.
This health centre in Buyende has become a spring of life for mothers; they are given improved care, transport and medication.
There are several such pilot centres across the three districts of Buyende, Kamuli and Pallisa in eastern Uganda. Eventually the services will spread across the country in rural districts with some of the worst maternal and infant mortality rates.
A study led by Dr. Elizabeth Ekirapa of Makerere University School of Public Health set out to find out why women in rural Uganda shun health centres. The project aimed at reducing the high maternal death in the country in line with the Millennium Development Goals.
Poverty a key factor
According to the 2006 Uganda Health and Demographic Survey, maternal mortality in these districts stands at an average of 435 deaths per 100,000 live births.
“Maternal mortality is very high in Uganda, with some rural areas having as high as over 500 deaths per 100,000 live births. These are pressing issues in all the areas in Uganda but this can be averted with modest investments in the health sector,†Dr. Ekirapa says.
She explains that a mother’s life can be saved and maternal mortality reduced if an expectant mother delivers with the help of a trained health worker in a health centre.
Dr. Ekirapa says during the study that commenced in December 2009, they noted that rural women do not access healthcare because of lack transport and long distances to the health centres.
“People do not have the money or the means of transport to health centres. The health centres too do not have enough supplies or maternity kits to support mothers. Most health centres even lack basic things like gloves or scissors,†she explains.
Nabirye comes from a poor peasant background where people depend on less than a dollar a day.
How the system works
Dr. Ekirapa says the project set out to address the challenges by giving mothers transport vouchers. On her first antenatal visit, a pregnant mother is given a voucher, worth sh5,000, which entitles her to transport to the health centre.
The woman calls a boda boda cyclist to transport her to the health centre. She presents the voucher to the cyclist and on arrival at the health centre, the cyclist presents the voucher to a cashier who pays him cash depending on the distance covered.
The project is funded by the UK Department for International Development and the Bill and Melinda Gates Foundation.
Another voucher entitles a pregnant woman to drugs, delivery kits, supplies like Jik and gloves.
Bearing fruits
Betty Naigaga, 28, says the voucher system has helped her to travel to the health centre for antenatal and post natal check-up. “Before that, it was difficult to walk here because I did not have transport. As such I had to deliver all the babies at home except this one. My husband is also happy and he accompanies me because there is transport.â€
According to Aggrey Batesaaki, the district health officer, deliveries in all health centres in Buyende and Kamuli districts have gone up 30% in 2008 to over 90%, with some health centres now lacking space for mothers.
He adds that antenatal attendance has increased from 20% in the past year to over 70%.
“Post natal attendance which was never there now stands at 70%,†he adds.
He adds that five out of 20 children used to die because they could not access health services. Currently, only one child out of 20 dies.
“In the past six months, only two babies have died because of pregnancy or childbirth-related complications.
Challenges
The biggest challenge now is that few mothers have access to family planning.
He says women in Kamuli district are very fertile with an average of about 12 children per woman and yet less than five out of a hundred are using contraceptives.
He explains that this has a negative impact on women’s health with dying of excessive bleeding during childbirth and others becoming weak and sickly due to the high number of children and lack of spacing.
Batesaaki says they are sensitizing women on the need to practise family planning. His main worry is that the safe deliveries project is a one-year programme that is likely to end in May 2011.
Dr. Ekirapa says if the project succeeds, they will roll it out to the rest of the country by engaging the Government and donor partners to provide the necessary funds.
He also points out the problem of staff shortages. For a district that has over 300,000 people, there are only 68 health workers, with no doctor. As a result some mothers die due to lack of qualified personnel to handle emergency cases like caesarean deliveries.
He also adds that supplies are often out of stock and he finds it almost impossible to distribute drugs to all health centres because either they are not enough or there is no transport.
IN the maternity ward of Nkondo Health Centre III in Buyende district, Rose Nabirye, 21, smiles at the newborn baby resting on her chest. As she recalls how, a few weeks ago, her baby stared death in the face, she is overwhelmed by relief that they are both alive.
For two days, Nabirye was in labour at her village in Ndulya, a village in eastern Uganda as she could not get to a health centre for lack of transport.
Luck smiles
Then luck smiled at her: a relative called Nkondo Health Centre III for support and a motorcycle was sent to pick her up.
Within just 20 minutes, Nabirye was at the centre in the hands of a health worker.
“It was a painful delivery but worth the effort; I would have died if I had insisted on delivering under the care of a traditional birth attendant,†she explains.
The mother of three adds that in the past, she lost a baby during birth because she chose to deliver under the care of a traditional birth attendant. The health centre was far and she had no money for transport.
This time, Nabirye gave the motorcycle rider a coupon worth 2,000 as transport fare and the rider presented it to the health centre workers and he was paid the sh2,000 cash.
This health centre in Buyende has become a spring of life for mothers; they are given improved care, transport and medication.
There are several such pilot centres across the three districts of Buyende, Kamuli and Pallisa in eastern Uganda. Eventually the services will spread across the country in rural districts with some of the worst maternal and infant mortality rates.
A study led by Dr. Elizabeth Ekirapa of Makerere University School of Public Health set out to find out why women in rural Uganda shun health centres. The project aimed at reducing the high maternal death in the country in line with the Millennium Development Goals.
Poverty a key factor
According to the 2006 Uganda Health and Demographic Survey, maternal mortality in these districts stands at an average of 435 deaths per 100,000 live births.
“Maternal mortality is very high in Uganda, with some rural areas having as high as over 500 deaths per 100,000 live births. These are pressing issues in all the areas in Uganda but this can be averted with modest investments in the health sector,†Dr. Ekirapa says.
She explains that a mother’s life can be saved and maternal mortality reduced if an expectant mother delivers with the help of a trained health worker in a health centre.
Dr. Ekirapa says during the study that commenced in December 2009, they noted that rural women do not access healthcare because of lack transport and long distances to the health centres.
“People do not have the money or the means of transport to health centres. The health centres too do not have enough supplies or maternity kits to support mothers. Most health centres even lack basic things like gloves or scissors,†she explains.
Nabirye comes from a poor peasant background where people depend on less than a dollar a day.
How the system works
Dr. Ekirapa says the project set out to address the challenges by giving mothers transport vouchers. On her first antenatal visit, a pregnant mother is given a voucher, worth sh5,000, which entitles her to transport to the health centre.
The woman calls a boda boda cyclist to transport her to the health centre. She presents the voucher to the cyclist and on arrival at the health centre, the cyclist presents the voucher to a cashier who pays him cash depending on the distance covered.
The project is funded by the UK Department for International Development and the Bill and Melinda Gates Foundation.
Another voucher entitles a pregnant woman to drugs, delivery kits, supplies like Jik and gloves.
Bearing fruits
Betty Naigaga, 28, says the voucher system has helped her to travel to the health centre for antenatal and post natal check-up. “Before that, it was difficult to walk here because I did not have transport. As such I had to deliver all the babies at home except this one. My husband is also happy and he accompanies me because there is transport.â€
According to Aggrey Batesaaki, the district health officer, deliveries in all health centres in Buyende and Kamuli districts have gone up 30% in 2008 to over 90%, with some health centres now lacking space for mothers.
He adds that antenatal attendance has increased from 20% in the past year to over 70%.
“Post natal attendance which was never there now stands at 70%,†he adds.
He adds that five out of 20 children used to die because they could not access health services. Currently, only one child out of 20 dies.
“In the past six months, only two babies have died because of pregnancy or childbirth-related complications.
Challenges
The biggest challenge now is that few mothers have access to family planning.
He says women in Kamuli district are very fertile with an average of about 12 children per woman and yet less than five out of a hundred are using contraceptives.
He explains that this has a negative impact on women’s health with dying of excessive bleeding during childbirth and others becoming weak and sickly due to the high number of children and lack of spacing.
Batesaaki says they are sensitizing women on the need to practise family planning. His main worry is that the safe deliveries project is a one-year programme that is likely to end in May 2011.
Dr. Ekirapa says if the project succeeds, they will roll it out to the rest of the country by engaging the Government and donor partners to provide the necessary funds.
He also points out the problem of staff shortages. For a district that has over 300,000 people, there are only 68 health workers, with no doctor. As a result some mothers die due to lack of qualified personnel to handle emergency cases like caesarean deliveries.
He also adds that supplies are often out of stock and he finds it almost impossible to distribute drugs to all health centres because either they are not enough or there is no transport.