My reflections on the COMONETH Project’s influence on safe family care practices in rural Uganda
By Cephas Mugerwa | I have recently completed a ten-weeks field study internship with Community in which Mothers and Newborns thrive (COMONETH). The project operates in rural Luuka District, about 150kms from Kampala, in Eastern Uganda. When I reported for my field study, COMONETH was about to start its Village Health Teams (VHTs) training sessions. The use of VHTs as an interventionist strategy run by community volunteers is a smart move. Research that used the three delays model found that Delay 1 – delay in deciding to seek care and Delay 3 – delay in receiving quality care once at the health facility accounts for most Maternal and neo-natal deaths in Eastern Uganda.
As a result, one of COMONETH’s interventions is to train VHTs in safe family care practices (FCPs). And the VHTs in turn, train and encourage women in their communities to adopt and apply these practices. The reasoning behind is that, if women are knowledgeable on the danger signs of a pregnancy and the FCPs of the newborn, they will not only promptly decide to seek qualified care, but also safely care for the newborn during the post-natal period. Each VHT therefore is responsible for community mobilization, preventive care and recently, some curative services. VHTs also act as a link between the communities and health facilities.
Recent research shows that there is an increase in public and private facilities. And while this is commendable, it is still short of the 85% target set in Uganda’s Health Sector Strategic Plan. Although there is an increase in health facilities, human resources to staff these facilities remains an issue. But while staffing remains an issue, government policy too needs to be revisited. There isn’t a medical doctor stationed at a Health Center III for instance. The highest qualified medical professional at a Health Center III is a midwife. A midwife is not trained to handle a caesarean section. In fact, research shows that only 5% of facilities are equipped to handle caesarean sections. It became clear to me why Delay 3 accounted for a high number of maternal and neonatal deaths.
I spent time accompanying VHTs on home visits. I accompanied a VHT to a health facility to visit a mother that had recently delivered her baby. A young girl, who looked not much older than nineteen, walked into the Health Centre. She was a mother of one-month-old twins and had a child that looked no more than 3 years old. The 3-year-old, by the way, was occasionally tasked with attending to one of the twins. She had apparently given birth to her twins at a traditional birth attendants home. I was curious to know her reasons for choosing the TBA over qualified professional care. It turns out she had a friend that had delivered her baby at a health facility but hadn’t received care and attention. She therefore figured that she would at least receive attention at a TBA’s home. And then she dropped a bombshell! The twins were a month old but had never received any immunizations! In 2018? I was shocked. And yet I ventured to ask why this was the case. For one, she lived so far away from the health center. She therefore did not have money for transport. She couldn’t walk the long distance carrying the babies, and her 3-year-old though handy, was not old enough to help her on the long trek. And what about your husband, I asked. He was not very supportive. Oh, and he had a second wife too.
As the days became weeks, I found that her situation is not an isolated case. Many women in Luuka District are stuck in the same predicament. There was nothing I could do for these women, except making every effort to publish their plight. And so, at the completion of my internship, I realize that I have gained valuable experience during my internship. Projects like COMONETH are positively impacting rural communities. COMONETH realized that it can help high risk mothers and their babies thrive by equipping them with the knowledge required to prevent maternal and neonatal deaths. And yet they too can only do so much.
The author is a Master of Public Health student with a bias in Global Health at Touro University California.