Blood, functional referral system, and skilled healthcare: The vital trio in reducing maternal mortality

By admin February 26, 2024


According to the recent Uganda Demographic Health Survey 2022 results (UDHS), I could not hide my excitement when I learned that the maternal mortality ratio had declined from 336/100,000 live births in 2016 to 189/100,000 live births as of 2022.

Despite commendable efforts to improve maternal health outcomes, challenges persist, hindering the nation’s progress toward achieving Universal Health Coverage (UHC) and the Sustainable Development Goal. However, amidst these challenges lies a vital trio; blood, a functional referral system, and skilled healthcare. These elements, when harnessed effectively, have the potential to improve maternal healthcare and propel Uganda towards the realization of UHC and SDGs.

Firstly, blood plays an important role in addressing maternal health complications, particularly obstetric hemorrhage, a leading cause of maternal mortality in Uganda.

According to the views obtained from the International Maternal Newborn Health Conference (IMNHC), 2023, which concluded that safe blood availability is crucial to reducing maternal deaths. Evidence underscores the significance of timely access to safe blood transfusions in saving maternal lives. However, blood shortages and inadequate infrastructure for blood banking persist as formidable barriers. Furthermore, in Africa, the availability of blood remains a challenge: only 47% of the blood supply is available, meaning that there is a 53% gap. The major portion of blood in Sub-Saharan Africa comes from voluntary, unpaid donors, which results in the continent not having access to adequate blood levels to sustain the general population.

To address this, strategic investments in blood collection, testing, and distribution infrastructure are imperative. Furthermore, robust community-based blood donation programs coupled with effective coordination between health facilities and blood banks can ensure a steady supply of safe blood, thereby mitigating maternal mortality due to hemorrhage.

In Uganda, the Karamoja region has been known for having the worst health indicators, but it took everyone by surprise when the region had its districts among the 10 best-performing districts according to the 2022/23 Uganda annual health sector performance report, one of the driving factors was the establishment of a central blood bank at Moroto regional referral hospital.

This was made possible with the efforts of implementing partners like Doctors with Africa (CUAMM), Uganda Blood Bank, and the Uganda Ministry of Health, with support from the Irish Embassy. Karamoja has not been left behind; at least a significant step has been taken; they have been able to collect 8,193 units of blood out of 5400 targets collected, surpassing the target.

Secondly, functional referrals are indispensable in ensuring that pregnant women receive timely and appropriate care, especially in cases requiring specialized interventions beyond the capacity of primary healthcare facilities. Life-threatening obstetric complications usually lead to the need for referral and constitute the commonest direct causes of maternal deaths. Urgent management of referrals can potentially lower the maternal mortality rate.  The National Development Plan II (NDP II) 2015/16- 2019/20 emphasizes; strengthening the referral system to ensure continuity of care including the Uganda National Ambulance Services, taking care of hard-to-reach areas such as islands and mountainous areas. Unfortunately, delays in referrals significantly contribute to adverse maternal outcomes.

Strengthening referral systems through improved communication channels, enhanced transportation networks, and capacity-building initiatives for healthcare providers is essential. Moreover, leveraging technology, such as telemedicine and mobile health applications, can facilitate swift and accurate referrals, bridging geographical barriers and ensuring equitable access to maternal healthcare services across Uganda.

Thirdly, skills acquisition among healthcare providers is paramount in enhancing the quality of maternal healthcare delivery. Evidence-based practices, including emergency obstetric care and skilled birth attendance, have been proven to reduce maternal mortality substantially. The World Health Organization (WHO) concludes that skilled attendance during childbirth is “the single most important factor in preventing maternal deaths”

However, the shortage of skilled healthcare professionals, particularly midwives and obstetricians, remains a pressing issue. To address this, comprehensive training programs, continuous professional development initiatives, and incentive schemes are indispensable. Additionally, fostering interdisciplinary collaboration and mentorship programs can harness the collective expertise of healthcare teams, thereby optimizing maternal health outcomes.

In conclusion, the convergence of evidence-based interventions centered around blood, referrals, and skills holds immense promise for advancing maternal healthcare in Uganda and achieving Universal Health Coverage together with Sustainable Development Goals. However, translating this potential into tangible outcomes requires concerted efforts from policymakers, healthcare professionals, and community stakeholders alike

By Judith Grace Amoit