“SOS for Blood gp B+ any centre with this gp please we need rescue We have received a ref in WITH APH active bleeding severe anaemia para 3, 34wks. None in collecting centre and nearby facilities checked so far.”
Members of the WhatsApp group “Advocacy for MNCH in Busoga” who were active online at 18:36 hours on September 1, 2019 were treated to that hurriedly typed message of a desperate health worker at the Jinja Regional Referral Hospital in Eastern Uganda.
If the ‘shorthand’ in the message does not make sense to you, put simply, the health worker was reaching out to colleagues (most of them subscribed to the above WhatsApp group) in neighbouring facilities inquiring if any had Blood Group B+ to rescue a mother of three who had just been referred in with severe bleeding and she was 34 weeks pregnant.
While similar pleas on this group from various hospitals have yielded results, this particular cry did not yield any solution. An hour later, the desperate Health Worker posted an update: “We lost her at 19:05 hrs …” This means there was only 30 minutes to try to save Naula Alisat from Mayuge District.
The next morning it emerged that another mother, Nambozo Rose, referred in from a Health Centre IV less than 10 kilometres away from Jinja town had died the previous night, also as a result of failure to get blood. A third one survived by a whisker when her blood type was secured just in time. These mortalities, coming just a few days after staff had just got a pat on the back from management after going for several months without registering a maternal death, were heart breaking.
The challenge
None-the-less, it is these and related preventable deaths that blight Uganda’s dreams of capping needless maternal deaths which stand at 336 per 100,000 live births. According to the Health ministry, maternal mortality in Uganda has declined from 505 deaths per 100,000 live births in 1995, to 336 deaths per 100,000 live births in 2016.This translates into an average of 18 women dying every day, which statistic the two maternal deaths in our opening anecdotes just contributed to.
With a huge and intimidating mountain to ascend, Uganda developed a five-year investment case dubbed the “Reproductive, Maternal, Newborn, Child and Adolescent Health Sharpened Plan for Uganda 2016/17 – 2019/20” which is largely being funded through a loan from World Bank (USD 110 million) as well as grants from the Global Financing Facility (USD 30 million) and the Swedish Government (USD 30 million).
The RMNCAH (Reproductive, Maternal, Newborn, Child and Adolescent Health) investment case was influenced by the revised Health Sector Development Plan targets for 2020 of reducing the maternal mortality ratio from 336 to 219 per 100,000 live births, under 5 mortality ratio from 64 to 47 per 1,000 live births, infant mortality rate from 43 to 32 per 1,000 live births, newborn mortality rate from 27 to 15 per 1,000 live births and teenage pregnancy rate from 25% to 14%.
To the framers of the investment case, achieving the stated desired changes, this called five strategic shifts including: 1. Emphasising evidence-based high-impact solutions; 2. Increasing access for high-burden populations; 3. Geographical focusing/sequencing; 4. Address the broader multi-sectoral context; 5. Ensuring mutual accountability for RMNCAH outcomes. And if well implemented, this would avert an additional 6,350 maternal, 30,600 newborn, and child deaths.
Way forward
Speaking recently at the 2019 Uganda RMNCAH Symposium, the Commissioner for Community Health Dr Jesca Nsungwa Sabiiti said success lay beyond the available funding to a change in the way stakeholders play their respective roles.
“This will be achieved through a change of how we do our business. We know the interventions which save lives. We know what works best and we have tried many things, but the new thing is how we do business and the guidance is in the five strategic shifts in our investment case,” she told the symposium attended by hundreds of stakeholders from across the country.
Despite the significant investment that has been made in the beneficiary districts across the country regarding the five strategic shifts, Health ministry officials including the minister and permanent secretary are not impressed with some of the players, and they let this known at the RMNCAH Symposium.
“While a lot of effort has been made to improve maternal and newborn health through the Uganda Health Systems strengthening program, some districts are still keeping some equipment like incubators in stores,” Dr Diana Atwine, the permanent secretary disclosed asking duty bearers to follow up and have the equipment put to use.
Similarly, Minister Jane Ruth Aceng castigated district officials over sectarian and corrupt tendencies in the recruitment process, which she said puts the lives of the people at risk. “As district officials wait for sons, daughters, in-laws, and friends to graduate, due to sectarianism, death does not wait for mothers and children. This practice must stop.”
With just two years to the end of the investment case, Uganda may need to engage higher gears by more than doubling efforts to beat the 2021 deadline the country set of reducing maternal deaths from the current 336 to 219 per 100000 live births. The 2030 Sustainable Development Goal target of reducing mortality to 70 per 100000 live births is also just a decade away. That it took over two decades to achieve the current ratio of 336 per 100000 from 505 only casts cynicism with only a decade away to the 2030 SDG deadline. However, one may argue that this time round availability of resources makes it easier for Uganda to save more Naulas and Nambozos.