Drugs, facilities and solar power – but no midwife

The story of a rural Ugandan health centre.

In a very remote part of Luwero district, Uganda lies a government owned health facility that caters for 50,000 people.

Powered by solar energy, when fully functional it can deal with seven to ten labours a day.

But women complain that the services of the only midwife at the facility are bad. They say she is rude, and when pregnant mothers come to the facility they have to wait a long time to be attended to. As a result, the majority opt for antenatal services at the centre but prefer to deliver with traditional birth attendants or seek the services of private practitioners.

Mr. Seentongo Appollo, a nursing health officer at the centre, says: “We do not see the women for deliveries. We have so many women coming here for antenatal care but none during deliveries. We want those women to deliver at the health centre.

“Even when the women have been assisted by the traditional birth attendants to deliver, please quickly send those women to the health facility. They could need PMTCT [preventing mother to child transmission services]; children need to be immunized and taken care of.”

There is very little influence on the midwife from her local employers, the local government, since she was posted to this rural place by central government. The last time a midwife was posted here she did not report for fear of the area and the dusty road. If this latest midwife is fired the health centre could face another two years without a full time midwife while a replacement is found as this is what happened before.

The major credit to this health centre is that the facilities and drugs are provided free and are available. The other bonus is that it has a nursing health officer Mr. Appollo, who is multi-skilled and regularly performs deliveries when the official midwife is AWOL.

He says: “On several occasions I am faced with a situation when I am the only one on duty when a woman is brought here with labour pains. I have no choice but to call a colleague to assist me in effecting a good delivery. I have carried out more than 15 successful deliveries. There is no problem since it enables me to shift to another task and help in crisis to save life.”

There is a critical shortage of human resource for health in Uganda. According to the World Health Organisation (WHO), Uganda is among seven countries with the worst human resource shortage of physicians, nurses and midwives.

Documents from the Uganda Ministry of Health indicate that the number of health workers has significantly increased in the past seven years, with an estimate of approximately 1.8 health workers per 1,000 people in 2011. But this is still far below the WHO minimum standard of 2.3 workers per 1,000 people.

In addition, the Ugandan government has not allocated adequate funds to increase the recruitment and retention of health workers. As a result, in the Uganda public service only 56% of the approved positions are filled. When you add to this the brain drain and huge rates of absenteeism (such as the case of a midwife noted above), the country is likely to face many more cases of poor staffing leading to poor performance in the health sector.

There are places that may not be ideal to work in, and taking control of employees in hard to reach areas may be a great challenge, but institutional mechanisms to monitor performances of such employees need to be put in place.

In cases where employees are designated to work in emergency situations and do not do so there is also a need for Plan B, C and D.

Where the people need it so much we must reduce these gaps in service delivery.

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