For the last two days I have been on a trip with the US Mission in Uganda to tour health projects that the US government supports in western Uganda. Two districts of Kyenjojo and Kabarole are somewhere the areas where the US government is partnering with different health facilities to support an ambitious government plan to reduce maternal deaths in four western Uganda districts by 50 percent by end of 2012. In the two days we visited 7 health centres including a regional referral hospital. Some were run by faith based organization, one privately owned and others government run.

A woman waiting in a line at Mitandi health center, a faith based center.

Uganda has one of the highest maternal mortalities in the world. At 435 mothers per 100,000 live births that translates to 16 mothers a day.
Over the years the Uganda’s political leadership have found a scapegoat in health workers blaming them for the poor healthcare delivery system despite wide research on what many see as a crumbling health system.

On the trip was President Barack Obama’s top official in charge of health at the State Department, Lois Quam who heads the Global Health Initiative (GHI).
GHI was brought in when President Obama assumed office to ensure a coordinated foreign health support.

The US government has concentrated on maternal health in these districts that have some infrastructure to gauge what difference their interventions can bring.
The programmes are on voluntary family planning, skilled care at birth as well as emergency obstetric and postpartum care. The American government provide over $400 million annually in health assistance to Uganda.

I met great doctors and health workers who work with so little to save lives. Their stories I will run in the next few days.

I was able to talk to Christopher Dorval, Senior Advisor; Strategy and External Relations at the Global Health Initiative. He says to make a big reduction in numbers of women dying due pregnancy complications, Uganda leaders must show political will.

QN: Explain briefly what work GHI does?

Mr Dorval: President Obama started the global health initiative and what he wanted to do was to take all investments that the US has made with partners around the world and try to bring much greater focus on the countries to assume more and more of their health care burden.
We want to work with countries like Uganda to begin to take control of their own healthcare. Instead of the US coming and trying to supply HIV/AIDS drugs but the question was how do we work together so that Ugandans own the system and ultimately it to benefit people of Uganda. We are trying to move away from disease specific investment where you go look at TB, Malaria,
It is great and we will continue the support but we want to treat as a person as a whole. If it’s a woman, we want to make sure they get family planning, malaria, immunization, and maternal assistance if they are pregnant. We want the countries to have health systems not just one disease based solutions.
Everybody needs to benefit from that health system and that’s what the GHI is all about.

(President Bush was famous for funds he availed for HIV but the focus on HIV moved attention to leading killer conditions in Uganda)

QN: How do you gauge Uganda’s healthcare system and response to maternal health?

We think the government needs to do more, we are not satisfied that government is doing enough, we think the people want and demand greater maternal services so we are trying to look at very specific interventions that no one else has done. It is simple interventions but they crucial that if you don’t do them a woman is going to die.
And what we have seen in Kabarole and Kyenjojo is the difference between the woman who lives and the one who dies are simple things like transportation, blood supply, a well qualified health assistant and ability to refer them in an emergency facilities. These are things that should be done and can be done.
Every single maternal death and infant death is preventable and we are saying we have to solve that and if you tackle that you will improve society greatly.
If we don’t solve it how is the country going to be strong when their women are in villages and can’t deliver safely, what does it say about a society and the country? A country that’s leaving behind women and they are not being able to contribute to their country.

QN: How sustainable are your interventions?

Most of the things we are talking about are less about money. They are more about simple interventions, there are plenty of Boda Boda (motor bikes) drivers and some people who are unemployed could learn how to design and make little ambulances to carry women. Everybody has a cell phone even in remote areas. They could call in advance and ask for a Boda Boda or ambulance whatever it takes. We need to build up simple systems and simple interventions that mean the difference between life and death.
They are sustainable in large part because they are simple. The challenge is in the villages and government has to have the political will to say we are sick and tired of seeing women and die and we are going to change it. It is not that difficult but shame on us if we can’t make it. It doesn’t cost a lot.

Note: The US government has funded a voucher system through different partners where women pay as little as 3000 Shillings (1.5 USD) to access antenatal, delivery and attendance for any complications. In various centers where I visited they reported a huge increase in mothers coming to deliver in health centers with this system. Also some money is paid to the Village health teams (VHTs) who provide health education, follow up mothers to take up antenatal as well as delivery. Again this has had positive results in the numbers of women delivering as health facility as well as increase the impact of prevention of mother to child transmission of HIV in some cases from as high as 15 percent to 2 percent in just one year.
I will be writing more detailed reports of challenges and experiences of health workers even when such interventions are in place.