White Ribbon Alliance

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November 17, 2014
Kabale is a lovely spot - green, mountainous, peaceful – the kind of place tourists love to photograph from 4x4s on their way to see the gorillas.

But much as its far flung hamlets may look romantic, living here all too often means death for women in childbirth. For should anything go wrong – the baby gets stuck, the woman bleeds or starts fitting – it is 30K to hospital along the roughest of roads.

A year ago Kabale did not have a single doctor to care for these women. What professional wants to work far from friends and family, without electricity or a decent house to live in, after the long years of study and financial sacrifice?

Today, thanks to White Ribbon Alliance’s campaign ‘Act Now to Save Mothers’, Kabale has six doctors. The challenge now is to keep them.

Before signing up, the doctors (five men and one woman) visited Kabale, and collectively wrote to the District Health Officer, pinpointing the challenges and suggesting solutions:

The challenges included inadequate staff. “No facility has anaesthetic personnel and yet such are very important for the functionality of the available theatres,” they observed. “This is really absurd because the area has a relatively high population and many responsible persons in this country were born in this area including the current Minister of Health and Governor of Bank of Uganda!”

The doctors noted limited staff accommodation. “Some staff members were found living in rooms which are meant for clinical work. (In one health centre) six staff members are occupying the doctor’s house and it seems rather unfortunate if a doctor displaces the six members for one person without getting them an alternative accommodation.”

Lack of electricity supply means no reliable light, no refrigeration of blood and drug supplies. “Most of the centers have the national grid lines in the vicinity, but the power is not connected to the buildings.”

Transport problems made it difficult not only for women to reach the health centres, but for doctors to refer emergencies to hospital. “The roads are difficult to use especially in the rainy season when transferring a critically ill patient to or from the center would really be difficult.”

They suggested solutions: one way to motivate doctors is to offer higher pay in rural areas as where there is no chance to “supplement a little income” through part-time work (as doctors do in urban areas.)“Therefore, we suggest that the leaders in the area find an extra-ordinary way of making doctors stay in Kabale by topping up the monthly salary in preference to other areas, otherwise we shall have a situation where the available doctors will always be thinking of going to other areas!”

The doctors expressed their “wish that at all times there are two doctors at all these centers” and that “electricity really needs to be connected to the center which we believe is not hard and we are wondering why the responsible bodies cannot give free power to the health center?”

All this shows rapid progress since the 2013 launch of a citizen led campaign, coordinated by White Ribbon Alliance Uganda, in the districts of Kabale, Lira and Mityana. The government of Uganda had already committed to increase comprehensive emergency obstetric and newborn care services in district health centres (level IV) from the existing 17% coverage to half of all such centres across the country, and had promised that basic emergency obstetric and newborn care services would be available in all health centres.

The plan was to hold the government to account for its promises, and the campaign began by involving the community in a survey to assess the reality of services. It was then that White Ribbon Alliance discovered that Kabale had no medical doctor in any of its seven health centres (level IV).

Since then Kabale residents have used these findings in talks with district and national leaders, in petitions to District decision makers and Parliamentarians, and in a national media campaign. The willingness of district political and health sector leaders to be involved has made a huge difference; they see themselves as key to the solutions, actively participating in health facility assessments and other campaign activities.

Dr Patrick Tusiime , Kabale’s District Health Officer (DHO), led efforts to find medical doctors to work in the district. “Despite the many challenges there is a ray of hope, our efforts have indeed started to pay off,” he told White Ribbon Alliance leaders. “I thank our partners for complementing the work of the district under the health sector. In a special way I thank WRA Uganda for dedicating time, resources, advocating and convening stakeholders around maternal and newborn health in the district and at national level. You have helped to refocus our health department priorities and generated ideas for improving maternal and newborn health service delivery.”

It was during a district leaders meeting convened by White Ribbon Alliance Uganda on 17th October in Kabale that Dr Tusiime confirmed three medical officers had reported to their stations at Rubaya, Hamurwa and Mparo HC IV respectively. Others will go to Kamwezi, Maziba and Muko HC IVs. “These medical officers are all young people and there is a need to be mindful of their personal ambitions and career growth. We have to explore all possible ways to motivate and retain them,” Tusiime cautioned.

In a room filled with District Councillors including the District Speaker, Secretary for Health and Secretary for Finance, the District Health Officer called on them to support and prioritize renovation and construction of staff houses in the planning and budgeting process for 2015/2016. He added that there is need to continue advocating to central Government to increase financing of district lower health facilities, strengthening community participation and public private partnerships.

This is the kind of locally specific and detailed work that district level advocates can do because they know the problems, they know the solutions - and they know the people involved: “We are currently facing a short supply of anaesthetic personnel on the market but the district has a three prolonged approach to address this gap” said Dr Tusiime. “A plan is underway with the District Service Commission Chairperson to advertise the vacant posts. We are also discussing with the management of Kabale referral hospital how to support the health centre IVs in case we fail to get the staff. The medium term solution will be to identify qualified persons among existing staff and recommend them for training in anaesthesia at Mbarara University and bond them for a specific period of time before they think of working somewhere else,” Dr Tusiime said.

In response, the District Councillors unanimously agreed to push for a recommendation of a top-up allowance for the doctors in the next council meeting slated for November 2014. The district councillors also concurred that motivation is not all about monetary benefits. They agreed to visit and meet with the new doctors and old staff at the health centres as a sign of care, and also to talk to them about what the district plans to do to improve their working conditions.

Samuel Senfuka of White Ribbon Alliance Uganda believes the campaign has made rapid progress, but there is much still to do. “As a minimum” he says, “the Government of Uganda must increase funding to fully equip Health Centres III and IV with trained, motivated health workers and the tools they need to provide effective emergency care. And as citizens we have to keep up the momentum and act as watch dogs to ensure that these promises are kept.”