Maternal Health Care Wins District Vote in Uganda: One District in Uganda Has Dramatically Reduced the Number of Womens' Deaths Due to Pregnancy and Childbirth. Now the Government Is Considering How to Extend the Same Level of Maternal Care to Women to the Country's Remaining 75 Districts
Nakazibwe, Carolyne, Bulletin of the World Health Organization
When Dr Godfrey Egwau, a consultant obstetrician at Soroti Regional Referral Hospital's maternity unit, stood for parliament in February, voters knew that if he won he would move to the capital, Kampala, about 280 km away.
Women in Soroti district weighed this and overwhelmingly voted for his opponent. Egwau, who dreamed of going into politics, lost the election.
Many associate Egwau with the high standard of maternal care provided here. He is proud of the district's record, but says the good work is not his achievement alone.
"When I stood for parliament in the last elections, they refused to vote for me, saying 'this is our good doctor, he cannot go!' It's true, we have succeeded, but we need to move away from individualization," Egwau said.
Many women across Uganda give birth without knowing whether they are HIV positive.
But pregnant women, like Connie *, who come to the Soroti hospital receive routine HIV counselling and testing. Of some 500 admissions a month, 30-40 test positive and are provided with treatment to prevent transmission of HIV from mother to child.
When the 22-year-old mother's result was positive, she was given medicine to prevent her from infecting her daughter, counselling, and she was put on antiretroviral (ARV) treatment.
Since February 2005, life-saving ARV medicines have been provided free to patients in Uganda who are HIV positive.
Soroti district became the test ground for a pilot of the WHO programme, Making Pregnancy Safer (MPS) from 2001 to 2004, the central principle of which is to make skilled care available for every birth. Since then, the district has continued to provide this high level of maternal care. Thousands of women like Connie have benefited.
Uganda is one of many countries taking the MPS approach, including Bangladesh, Bolivia, Kenya, India, Indonesia, the Lao People's Democratic Republic, the Republic of Moldova, the Philippines, Timor-Leste, the United Republic of Tanzania and Zambia.
"The success of the Making Pregnancy Safer initiative in Uganda is evidence enough that with proper technical, financial and social support of whatever kind, and by working directly with local governments and health managers, we can make a difference," said Dr Quazi Monirul Islam, Director of WHO's Making Pregnancy Safer Department.
According to a report entitled: Making Pregnancy Safer in Soroti, presented by Egwau in September this year, Soroti district reduced maternal mortality from 750 deaths in 2000 to 190 deaths for every 100 000 live births in 2006.
"Our rule is simple: for each mother there must be a baby to go back with and for each baby, there must be a mother to go back home with," Egwau said. "It is an exciting thing to work in this district, because you see results."
Under the WHO programme, according to Egwau, 43% of women living in Soroti now give birth with help from a trained health worker, as opposed to 26% before the MPS project started. …