Erin’s second night in Uganda

Uganda faces a maternal mortality ratio of 435 deaths for every 100,000 live births. That means for every 100,000 women, 435 will die and that number has remained stagnant for years.

Today we woke up and packed in the car for a five-hour drive to western Uganda. By way of background, the Saving Mothers, Giving Life (SMGL) partnership that we’ve been working on has focused on four districts in the western part of the country. We got here and settled into our little Mountain hotel and had a fantastic briefing with the team. I am continually blown away by what’s actually happening when I get here and hear about it. Tomorrow we get to start SEEING all that’s taking place here, but just to set the scene- let me provide an overview of the works that have been set in motion.

Lets review the setting. Uganda faces a maternal mortality ratio of 435 deaths for every 100,000 live births. That means for every 100,000 women, 435 will die and that number has remained stagnant for years. The goal is to cut that number to 130 by 2015. Here in these four districts of western Uganda, there are 80,000 births every year and the fertility rate is even higher than the national average of six children per woman (which as you can guess, is high).

So the Saving Mothers, Giving Life partnership is geared to try to reduce maternal deaths by up to 50%. Sounds crazy ambitious but goals are a good thing. To do that, the initiative is focused primarily on the 24 hours between the onset of labor and 24 hours post partum. To address deaths that take place in this window means that pregnant women need to be identified. Then they need to see a skilled provider when they deliver. Ideally they’ll also see a provider for antenatal care.

Tonight we discussed with the team what the primary strategies are to ensure women get the care they need. There are five strategic priorities:

1. Increase access to care. This includes transportation, communications strategies and upgrading facilities. We talked a lot about transportation and the various voucher approaches like the one that EMC is supporting (more on that late this week as we see it in person). Clearly transportation is a huge issue here. We looked at a map showing the distances women have to travel in Uganda and learned that only 13% of women live within two hours of WALKING to a facility and 55% of women live within five hours of travel time (by vehicle) to a facility. A map showed large areas where women have to travel more than eight hours to get to a facility.
2. Improve the quality of services. This category includes training, community feedback and making sure facilities are woman-friendly. There are just far too few providers to serve the women in need and things like emergency care are way too hard to access. The team here has hired 111 midwives and 85 other health professionals to help reach more women. In total, the government has approved 6300 hires in the health sector, which will help tremendously. One amazing statistic I saw was that as recently as 2008, only 10% of the facilities that should be able to provide C-sections can actually do so, but all that is on the mend. In these four districts, thanks to SMGl, all of the clinics that are supposed to provide these services are on track to do so by the end of the year.
3. Increasing demand for services. Women have to WANT to get care and have to seek it out. If their moms and their grandmothers didn’t deliver with a trained professional, it might not be totally natural to seek it out themselves. Or maybe when they tried once before, the services were so poor that they just weren’t inspired to try again. Voluntary health workers are doing a lot to change that by going into the community and educating women and communities about the benefits of delivering with a provider. Radio spots, billboards and other mass media are helping get the word out too.
4. Improve health systems. Maternal health services are the main indicator for how a health system is functioning and it’s true that you can’t just improve maternal health in a bubble. The whole system has to improve to some extent.

So that’s that. I’m curled up under my bed net, hoping to catch some Internet somewhere to send this in and eager to see it all in motion tomorrow. More to follow!