With the delay in decision to seek care and a delay in reaching care already among the leading contributors to maternal mortality in Uganda, there was widespread fear when in late March Government announced a lockdown and a strict nighttime curfew following the arrival of COVID-19 in the country. And indeed, a couple of fatal incidents were reported in the press.
However, for the eastern Uganda district of Pallisa which has partnered with Makerere University School of Public Health (MakSPH) on several maternal and newborn health implementation research projects, saving her mothers was among the top priorities.
At the start of the lockdown, President Yoweri Museveni directed that each of the over 100 districts in the country avails all running sectoral vehicles to their respective health departments. And for Pallisa, ten vehicles were made available for the COVID-19 response in the district. However, given that the novel corona virus was just emerging with a few alerts here and there (all of which were negative), it meant that most of these vehicles were going to be redundant. It then occurred to the Health department that there were struggling mothers and others critically ill patients in the district.
During a recent stakeholder meeting under the auspices of a MakSPH pilot that is exploring the factors that facilitate or constrain the implementation of the Maternal and Perinatal Death Surveillance and Response (MPDSR) protocols, the Pallisa District Health Officer Dr Godfrey Mulekwa shared how his team went about saving up 300 mothers by minimizing the two delays alluded to earlier.
“We anticipated the difficulties that mothers were bound to face. After being availed with ten pick up trucks, we established an ambulance system. We publicized all the key contact telephone numbers. So as the response teams went out after attending to COVID-19 related business they would emphasize that all health services were still operational despite the corona virus outbreak in the country.
With this reassurance, we started getting calls from families with mothers wanting to access services in health facilities. We also got calls for critically sick people including the elderly and children. The vehicles kept picking them and by the end of June when the lockdown eased, we had transported 850 people out of which 300 were expectant mothers. And out of these, we had only one facility maternal death. This death is attributed to a late decision by the family to seek care. She experienced a placenta abruption, over bled and by the time she reached the facility it was too late to save her as she died soon after arrival.
What we learnt from these three months is that with such minimal investment, it is operationally possible to save mothers and other critically sick people by offering them transport to health facilities. It does not require a lot of resources. Increasingly, districts have also become small making it possible for a vehicle to pick a mother or sick child from any district corner at any time. We did it during the lockdown and it is possible even beyond the lockdown if the minimal resources are made a priority.”
Speaking at the meeting, MakSPH’s Dr Elizabeth Ekirapa-Kiracho who is also the lead researcher on the Makerere University funded MPDSR study urged the district authorities to document and showcase their lessons with the Health ministry to inform policy and practice.
“The ministry needs such success stories for consideration as they go about formulating policy and guidelines. You can add this to the body of evidence that the ministry gets from different stakeholders,” she said.