Photo Credit: White Ribbon Alliance Uganda.

My Efforts to Improve Services for Pregnant Mothers Saved My Wife’s Life

Because of citizen-led advocacy campaigns, leaders are now responding to citizens’ demands and rights — and countless lives are being saved in Uganda

By Denis Okwir

Denis Okwir is a citizen journalist and community-based monitor trained by White Ribbon Alliance. He is also the Project Coordinator for Youth for Life Uganda. He shares how his work, together with other citizens in Lira District, Northern Uganda, has enabled expectant mothers to access emergency obstetric and newborn care services at health facilities within their reach.

Denis Okwir, his wife, and new baby girl.

This past June, my wife was among the 12 women who successfully delivered by emergency Cesarean section at Ogur Health Centre IV since the theatre began operating four months before. My family lives in Ogur Sub-County, Lira District, in Uganda, but we could not access operating services in our area during her first pregnancy three years ago. She had a complication that necessitated an operation and we had to go to Lira Regional Referral Hospital, which is 20 kilometers away.

At the hospital, we found 45 mothers in the ward with no privacy at all, despite the fact that I later learnt that the ward was meant to accommodate just 15 women. Her operation was successful, though, and she gave birth to a baby boy.

My role as a citizen journalist has put me in touch with many leaders at the district who have appreciated the work I have done.

This time, on June 2nd, 2017, when I was away from home, she was taken by a relative and admitted at a private health facility in Lira with leakage of her amniotic fluid, even though she was only eight months pregnant. They conducted a scan which showed the fluid levels were normal. She was treated and discharged with some medicine after a week and a half.

However, her condition did not improve much. So I decided to take her to Ogur HC IV, since I knew the operating theatre there was functional. I could not have managed the fees charged by the private facility to operate on her if that was an option. An operation there goes for a whopping Shs 500,000 (about 140 dollars).

Denis Okwir’s wife during her emergency Cesarean section.

At Ogur HC IV, the doctor recommended a scan which we did and the results indicated that the fluid level was low and she needed an operation within four hours. Luckily, the doctor at Ogur HC IV, Dr. Okullu James, was still on a general ward round. Upon seeing her scan results at 4pm, he made an appointment to operate on her at 7:30 pm. The operation was successful and she delivered a baby girl.

I am thankful to White Ribbon Alliance for the camera and other skills they have given me that have enabled me to confidently advocate to decision makers to provide life-saving care for pregnant women and their children.

I am so happy to benefit from my hard work together with other citizens in Lira who have demanded that the government fulfills its commitment to provide Comprehensive Emergency Obstetric and Newborn Care (CEmONC) at health center IVs and Basic Emergency Obstetric and Newborn Care (BeMONC) at health center IIIs.

My role as a citizen journalist has put me in touch with many leaders at the district who have appreciated the work I have done. I am thankful to White Ribbon Alliance for the camera and other skills they have given me that have enabled me to confidently advocate to decision makers to provide life-saving care for pregnant women and their children. Whenever I show them the photos highlighting problems at heath facilities, they believe me very quickly and have been able to act and improve the situation. The leaders sometimes call me to escort them during their monitory visits to the health facilities. I am happy to be part of the solution. In fact, Dr. Okullu James jokingly introduced me to his team (many of whom are new),that I am one of the ‘staff’ who devoted their time and efforts to ensure that the theatre is functional. I was very happy and felt appreciated for my work.

We petitioned our Woman Member of Parliament Hon. Joy Atim Ongom over poor maternal and newborn services at government-owned health health centre IIIs and IVs. Because of that petition, health workers have been recruited, theatres renovated, and more citizens now know what they are entitled to. They have been empowered and can now challenge leaders when something is amiss.

The functionality of the theatre has reduced the burden of transport cost to mothers amounting to Shs70,000 (about 20 dollars). We have been at Ogur HC IV for two weeks, and I have heard several mothers and caretakers appreciating the work of the doctor and his team. The availability of the doctor has given them confidence in the capacity of the health facility to manage complications that may arise. The operations that have been done so far have become the talk of the area. Betty Enying, a caretaker said; “It’s easy to look after your patient when they are here (at Ogur) instead of the regional referral hospital. We have to transport food and other items for our patients, but when they are here, the food even arrives when it’s still hot. The hospital is far and there is a lot of transport needed to go there.”

Ogur HC IV had last conducted an operation in 2010. Since 2013, I, together with the community, health workers, district leaders, and media have been pushing for the renovation and functionality of theatres at health centre IVs in Lira District, 350km from Kampala. We petitioned our Woman Member of Parliament Hon. Joy Atim Ongom over poor maternal and newborn services at government-owned health health centre IIIs and IVs. Because of that petition, health workers have been recruited, theatres renovated, and more citizens now know what they are entitled to. They have been empowered and can now challenge leaders when something is amiss. Leaders are now responding to citizens’ demands and rights.

Denis Okwir’s wife after delivering her baby via an emergency Cesarean section in the clinic he helped campaign for with WRA Uganda.

Read what members of Parliament in Lira and Kabale Districts said about these advocacy efforts here: Citizens claim and enjoy their rights to life saving services.


WRA Uganda’s Act Now to Save Mothers Campaign mobilized citizens and health workers like midwives across Uganda to demand their health rights. Photo credit: White Ribbon Alliance Uganda.

WRA Uganda’s Act Now to Save Mothers Campaign

CHANGE NEEDED — A MATTER OF LIFE OR DEATH

· 17 mothers and 106 newborns were dying everyday from preventable and treatable causes including hemorrhage, sepsis, unsafe abortion, eclampsia, obstructed labor and birth asphyxia.

· A campaign was imperative to raise these issues right from the community level so that citizens demand the Government of Uganda to increase funding to fulfill its commitment of providing EmONC services.

· In 2011, WRA Uganda advocated to the Government of Uganda to make a commitment to the UN Secretary General Strategy for Women and Children’s Health popularly known as Every Woman Every Child (EWEC).

· In response, the Government committed to ensuring that by the end of 2015: (a) half of the health centres IV at county level will provide Comprehensive Obstetric and Newborn Care (CEmONC) services and (b) All health centres will provide Basic Emergency Obstetric and Newborn Care (BEmONC) services.

· Act Now to Save Mothers (2013–2015) was an accountability campaign to advocate to the Government of Uganda to deliver on its commitment.

Photo Credit: WRA Uganda.

CHANGE BEGINS — CITIZENS TAKE THE LEAD

· The campaign needed evidence to back up the advocacy and demand for accountability.

· WRA Uganda worked with citizens, health workers, district leaders, policy makers, and the media to conduct health facility assessments in the three target districts of Kabale, Lira, and Mityana to ascertain the status EmONC provision in all government-owned HC IIIs and IVs

· Citizens were informed of government commitment to improve life-saving care for pregnant women and newborns with the aim of increasing their demand for EmONC.

· Uganda amplified citizens’ demands through working with media, maternal health champions, civil society advocacy coalitions, and utilizing opportunities at global forums such as World Health Assembly and United Nations General Assembly where citizens called for accelerated action to fulfill commitments to EWEC.

TWO YEARS LATER, CHANGE IS HAPPENING — LIVES ARE BEING SAVED

· The campaign results demonstrate that the empowerment of citizens with information about government commitments and their health rights, and supporting them to demand accountability, improves health service delivery.

· There has been a remarkable improvement in the availability and provision of EmONC services, with HC IVs starting to provide C-sections; improved procurement planning, stocking and availability of essential EmONC medicines and supplies; increased staffing of maternal and newborn skilled health workers and improved availability of newborn resuscitation devices to help babies to breath at birth.


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