Maternal Deaths Emblematic Of Rot In Uganda’s Healthcare System
Uganda has the uncanny ability of always popping up in the news. The last time my home country captured the imagination of the American public was in early June when the profane, potty-mouthed and hysterical musical “The Book of Mormon” won nine Tony Awards. The happily paradoxical “Book of Mormon” is about two dewy missionaries from Salt Lake City transported to Uganda and their misadventures.
Now the New York Times has come out with this: Maternal Deaths Focus Harsh Light on Uganda.
The article was spot-on. Wielding a slingshot that had its fingers on the pulses of Uganda’s expectant women, the piece threw brickbats at Uganda’s floundering public health system. Foreign aid donors were not spared either as the article questioned the unintended consequences of development aid.
The Birth And Genesis
The embers in the most-recent fiery debate about maternal mortality rates in Uganda were stoked on May 27, 2011 when the Centre for Health Human Rights and Development (CEHURD), a Ugandan NGO, and the families of two mothers who died in government hospitals in 2009 approached the Ugandan Constitutional Court alleging the women’s deaths were caused as a direct result of Uganda’s failing healthcare system. CEHURD, in this landmark petition, alleged that the circumstances that led to the death of these two women were both emblematic and symptomatic of the government’s failure to fulfill its constitutional obligations to provide basic maternal healthcare to expectant mother. They sought to arm-wrestle the government into increasing its budget for maternal healthcare and compensation for the families of the two women.
Accounts of the events that led to the death of the two women are almost the same. Councilor Anguko Jennifer, a civic official in Arua district, sustained a ruptured uterus while waiting for over ten hours to be attended to by a doctor while she was in labor.
She died on the theater table. Sylvia Nalubowa, a mother of seven, was not aware that she was to have twins. The antenatal clinic she attended in her area in central Uganda did not have adequate scanning facilities. When she went into labor, her husband could not raise money to transport her to Mityana Hospital and, according to reports, they had to ‘improvise’ transportation to reach that hospital, 15 kilometers away.
Unable to purchase a Ush 50 000 ($ 25) ‘mama kit’ for use at the hospital’s labor ward, she was left unattended and died. The mama kit package contains a meter piece of cotton cloth, laundry soap, a pair of gloves, a piece of cotton wool, small gauze, cord ligature, and a meter of polythene sheet for the delivery table.
The Sick Life Of Uganda’s Systems
Uganda’s health care system needs CPR. The NY Times story, emphatic in its articulation, painted the picture of a battered, bankrupt and decrepit tragedy.
“At regional hospitals like the one here in Arua, more than half the positions for doctors are vacant, part of a broader shortage that includes midwives and other health workers. A majority of clinics and hospitals reported regularly running out of essential medicines, while only a third of facilities delivering babies are equipped with basics like scissors, cord clamps and disinfectant, according to a 2010 Health Ministry report.”
The government’s response to the joint suit by CEHURD and the families of the two deceased expectant women was telling. Unaccustomed to such Zeus-style thunderbolts on the efficacy of its governance and the healthcare system, government officials dabbled uneasily in obfuscation, saber-rattling and shifting of responsibilities as they guarded their fief.
Uganda has seen rosier times. The Uganda Bureau of Statistics pegged Uganda’s inflation rate at 18.7 percent in July 2011, the highest since February 1993. According to data compiled by Bloomberg, Uganda’s shilling is Africa’s worst performing currency this year after weakening 12 percent against the dollar. Uganda is one of the countries with the highest child mortality rates in the world, according to the State of the World’s Children report.
She holds the 21st last slot out of 189 countries. At least an estimated 45,000 newborn deaths occur in Uganda each year and an equal number are stillborn, making her the country with the fifth highest number of newborn deaths in sub-Saharan Africa.
According to the World Health Organization, Uganda has the world’s highest malaria incidence, with a rate of 478 cases per 1000 population per year. The overall malaria-specific mortality is estimated to be between 70,000 and 100,000 child deaths annually in Uganda, a death toll that far exceeds that of HIV/AIDS. Tuberculosis remains a major public health problem in Uganda, ranking her 18th among the 22 TB high burden countries of the world. About 100,000 new cases of all forms are recorded every year.
A Post-mortem Analysis
Giving handouts to Africa remains one of the biggest ideas of our time — millions march for it, governments are judged by it, celebrities proselytize the need for it. Whenever funds are doled out, press conferences are held and kumbaya moments invoked. What is not ever sufficiently articulated is that development aid has, in some cases, done more harm than good to Africa.
“For every dollar of foreign aid given to the governments of developing nations for health, the governments decreased their own health spending by 43 cents to $1.14, the University of Washington’s Institute for Health Metrics and Evaluation found in a 2010 study. According to the institute’s updated estimates, Uganda put 57 cents less of its own money toward health for each foreign aid dollar it collected.”
In the history of mankind, no country has ever developed by depending on foreign aid. Dambisa Moyo, whose book Dead Aid I plowed through in January 2011, opines that Africa needs to be gradually weaned off development aid and the spigots finally shut off and African governments left to their own devices. Previously a lone dissenting voice, Ms Moyo is garnering a rapidly increasing roster of supporters willing to toll the death knell for foreign aid. More are jumping onto this bandwagon.
What should Uganda do to avert its maternal mortality crisis? Here is a list of suggestions from Ms. Magazine, a blog that prides itself in its ‘fearless feminist’ reporting. Emphasis needs to be placed on adequate remuneration for doctors and other healthcare workers. For a long time, it has been expected that health care workers should toil and serve with their morality’s engines powered by altruism, humanism and nationalism alone. That hasn’t worked. This may be anathema to donors but it needs to be put out there that health care workers with a ‘sufficiently oiled’ vested interest in Uganda are the key to preventing Uganda’s slide into healthcare Armageddon. With that in place, we will probably be seeing the last of the hemorrhage caused by maladies such as absenteeism, presenteeism, healthcare-related corruption and the brain drain. Next would be to institute an overhaul of Uganda’s healthcare system starting with the management of training of healthcare workers being returned to the Ministry of Health from the clearly over-burdened Ministry of Education and Sports.