Fearing Uganda’s health monitors; is it to blame for the preventable maternal and newborn deaths?
The Preterm Birth Initiative (PTBi) study of Makerere University School of Public Health and the University of California San Francisco recently organised in Jinja a symposium on leadership for continuous quality improvement which brought together hospital heads and district health officers from five districts in Busoga sub region.
PTBi aims to reduce illness and death from preterm birth by strengthening facility-based care from pregnancy through labour, delivery, and immediate postnatal period. In Uganda, the study is in six facilities including Jinja Regional Referral Hospital, Iganga, Bugiri and Kamuli General hospitals, as well as Kamuli and Buluba Mission hospitals.
What caught my attention at the symposium was a session in which participating teams were asked to review the most recent preventable neonatal death within the respective hospital settings. For purposes of this blog, I will focus on one case from one of the hospitals which I will reproduce thus:
“A mother came in after being referred from a Health Centre III with obstructed labour and we had to take her for a caesarean section. Unfortunately there were delays in acquiring what to use in theatre. The baby went into fetal distress and later was born as a fresh stillbirth. The preventable aspects were preparing ourselves for receiving these emergencies especially regarding supplies. I think we need to prioritise emergency cases by having some supplies in stock so that we do not waste a lot of time waiting for these mothers to go and buy and so on. Things for theatre like catheters, gloves and some other essentials that a mother needs for delivery.”
In my mind, I wondered why the fatalities if they knew what needed to be done to curb the unnecessary preventable deaths of mothers and newborns that leave families grieving forever. And thanks to the facilitator’s prompts, the answer to my silent question did not take long to come.
“Sometimes we are let down by the system. Previously, we used to preserve some supplies for such cases [emergencies]. Unfortunately sometimes the government was not happy about that. When the monitoring teams come and find such supplies reserved for such cases then they take it negatively. They think we are reserving them to sell.”
The monitoring teams being alluded to above is the dreaded Health Monitoring Unit (HMU) that was initiated by President Yoweri Museveni in 2009 following public outcry especially regarding the intermittent stock outs of medicines in government facilities. The monitoring has since gone beyond medicines and now covers service delivery in general. While it cannot be denied that the HMU has registered tremendous success over the last couple of years as seen in the convictions of culprits and recovery of government property, on the other hand as in the above case study, a trail of tears has been left behind as innocent lives are lost.
I cannot pass judgment here basing on this single case study but given the quivers that many health workers get when one mentions the HMU, chances are high that the fear is being felt across the country, further endangering many more live of mothers and newborns.
All public health facilities should be allowed to hoard some commodities to cater for obstetric emergencies without health workers fearing arrest as long as the hoarding is justifiable. However, this calls for good data in health facilities which for example show trends in emergencies and consumption of commodities. Numbers rarely lie.
None-the-less, obstetric emergencies will always happen, hence the need to have the requisite lifesaving commodities especially for use in theatre. If it is at the centre or the health facilities where the ineptness lies that is leading to preventable deaths, it should be fixed. Otherwise, we shall continue going around circles as lives are lost. It is annoying but also heart breaking to lose lives when in many cases someone somewhere in the system did not simply do what they were supposed to do.
About the Author: Kakaire Ayub Kirunda specialises in communication for development at the Makerere University School of Public Health.