According to the 2011 Uganda Demographic Health Survey, Uganda’s maternal mortality rate was found to be 438 per 100,000 live births. Sub-Saharan Africa is still the most risky region in the world for a woman to give birth. Uganda accounts for 2% of annual maternal deaths globally. This translates into 492 maternal death per month. This is a very high figure and yet we also know that most of the deaths are not captured by the health information management system which was the source of the maternal mortality estimates. One wonders how the mothers that died at home or on the way or never made it to a health facility are counted for or estimated.
This is why IDF is promoting interventions geared towards increasing access to maternal health service and responsiveness of duty bearers to citizen’s needs. Through continuous advocacy there is notable progress of staff recruitment especially midwives and nurses in the health facilities where Manyak Anti-Corruption Coalition (MACCO) has been implementing. The interventions have seen recruitment of over 15 new staff in five health centres in Arua District as well as the functionality of maternity wards in health centre IIIs in addition to the supply of equipment to 8 health centres. The SDG target on maternal mortality forms an integral part of the global strategy for women’s, children’s and adolescents’ Health, 2016–2030. Universal access to sexual and reproductive health is essential not only to achieve sustainable development but also to ensure that the framework speaks to the needs and aspirations of people around the world and leads to realisation of their health and human rights. In Olujobu health centre III in Rigbo in Arua district, the interventions have contributed to increased deliveries from 50 deliveries at baseline (2014) to over 150 deliveries now. One of the mothers who shared her plight said “when this health centre was being renovated, I had to walk a long distance, its 8km to Rhino camp health centre IV and I ended up delivering on the way. I was then taken by sympathisers to the hospital for check-up. I thank MACCO and all stakeholders for making sure that the maternity wing in Olujobo works, we can now access maternity services closer”.
MACCO, with IDF funding focused on the Citizens Advocacy on Rights and Development (CARD) as a sequenced process of strengthening health systems in order to continue impacting on the health service delivery. While empowerment of the people at the grassroots is a long term process, the CARD project demonstrated that it does not have to take a long time for the people at the grassroots to fully and actively support and participate in actions whose objectives address their immediate and long term concerns and interests. This is reflected by the CARD project’s immediate results as it provided an opportunity for communities to get involved in management of their own social services.
Olivu Health Center II was not functional, but after MACCO’s intervention in operationalising it, the unit now has nine staff working and also receives Primary Health Care (PHC) funds to facilitate outreach and other activities. A mother attending antennal care at the heath centre said “it used to be difficult for us to attend antenatal care because Rhino camp health centre IV is very far. Now we can attend from here because Olivu health centre II is near us.”
As a result of the CARD intervention, the average number of patients received at Olivu Health centre II alone went up from 0 at inception to 800 patients per month and an estimated number of 10 mothers per day for antenatal services. The human resource recruitments particularly midwives is an outcome of the sub county dialogues that were organized at the health facility level, attended by the key duty bearers who interfaced with citizens. Due to the persistent dialogues and advocacy, two midwives were posted to Yinga Health Center III which previously had none. Two nurses, a cleaner and a clinical officer were also recruited at Olivu Health Center II and a clinical officer at Odubu. Through the empowered communities, there have been major repairs in the health facilities where the project intervened like the case of Adumi Health centre IV where a new inverter was procured, batteries changed, the solar system repaired and constant power supply in the health unit. The bore hole which had broken down was also repaired supplying water to the health unit. The generator has been repaired and new bulbs fixed to provide lighting in the same facility.
Plans are underway to renovate a bathroom for the mothers. Such improvements not only reflect the power of engaging duty bearers but also the level of influence the citizens possess once they know their rights. A midwife at Olujobu health centre said, “You know, this health centre being in a refugee hosting Sub County has had a big number of mothers delivering here. But when it got cracks and had to be closed down for renovation, mothers walked to Rhino camp health centre IV and other health centres such as Ocea which are very far. We thank you for ensuring that everything is back to normal within this short time”.
The project has registered impressive results in making the HUMCs functional in 12 rural health units in Arua District. Strengthening the Health Unit Management committees (HUMCs) has resulted into better service delivery. They play their role in monitoring the health units, supervision of the health workers, sensitization of communities on hygiene and sanitation, organising meetings, developing plans and taking records of the delivered drug consignments by National Medical Stores at the health units among others.
CARD principle is grounded in the belief that true change must happen from the ground up, from the people like the community monitors, who need only to be given an opportunity and strengthened in terms of knowledge and skills capacity in order to enact the change they wish to see in their communities. The chairman, social services, Arua District commended MACCO for exerting pressure on the district local government to open Olivu health centre II because now the community is receiving health services. The combined efforts of an empowered community, duty bearers and operationalisation of systems contributes to the reduction of maternal mortality in the region and improved maternal health service delivery.