Experts advise on improving maternal health

By Francis Kagolo

AFTER improving community awareness on maternal health, Uganda now needs to channel more resources to increasing skilled labour attendants in health facilities if it is to curb the high maternal mortality, experts have advised.

Public health experts observed that having more pregnant women seeking care from hospitals as opposed to traditional birth attendants will not be enough to fight maternal mortality.

Dr. Jolly Beyeza, a senior consultant gynaecologist with FIGO Save the Mothers and New-borns project, said availability of essential drugs and supplies and motivated skilled labour remain the missing link to curb the problem.

“If the number of pregnant women seeking care from health facilities has gone up, why then is maternal mortality still so high? A good number of our health facilities lack skilled personnel to deal with pregnancy related complications and deliver women effectively,” Beyeza said.

“The ministry has to make a distinction between mothers delivering in hospitals and receiving skilled attendance. You find a woman delivering on the floor at Mulago. That is not skilled attendance.”

The concerns were aired during the annual maternal and new-born health symposium organised by Makerere University school of public health at Imperial Royale Hotel, Kampala on Wednesday.

In Uganda, maternal and child health indicators have been improving over the years but the progress remains wanting to achieve Millennium Development Goals 4 and 5.

The number of women delivering from home declined from 56% in 2006, to 42% in 2011, according to the Uganda Demographic Health Survey Report of 2011.

The number of mothers dying while giving birth has also declined from 550 deaths per 100,000 live births in 2001, to 438 deaths per 100,000 live births in 2011, according to the report. Infant mortality declined from 89 deaths per 1,000 live births in 2001, to 54 deaths per 1,000 live births.

The country is struggling with an acute shortage of midwives, which is partly responsible for the slow reduction in maternal deaths.

According to the Human Resource for Health Report of April 2009, Uganda had one midwife for every 5,000 mothers. The World Health Organisation recommends two midwives per mother in labour. 

“Many labour units are headed by nursing assistants who have no proper training in delivery and child birth.  What will change maternal health is not only women going to hospitals but increasing skilled deliveries across the country,” said Dr. Suzanne Kiwanuka of Makerere University.

Dr. Anthony Mugasa, the reproductive health advisor at the ministry of health, cited underfunding as the major challenge in maternal health provision. He asked researchers to partner with the civil society to lobby for increased government funding.

Experts suggested rolling out of Village Savings and Loans Associations (VSLAs) for health where pregnant women can draw funds for transport to health centers during emergencies. The strategy has improved maternal health in Kiboga district where FIGO tried it and in southwestern Uganda by Health Partners Uganda.

Others advocated for enhancing the capacity of Village Health Teams (VHTs) in rural areas for more mothers to seek antenatal and postnatal care from health facilities.

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