The promise by the Government of Uganda (GoU) that it will meet a target of adding slightly under 650 midwives to its payroll in the Financial Year (FY) 2025/2026 is reassuring. It signals much-needed intent to focus minds on the urgent need to improve birth outcomes and experiences in the country. While maternal and neonatal deaths have, in recent years, dipped, with a 2023 World Bank report putting the latter at 18 per 1,000 live births, deeply troubling failures in maternity services still stick out like the metaphorical sore thumb.
It is refreshing that-at last week’s staging of the fifth National Safe Motherhood Conference in Kampala- the GoU acknowledged that the sheer number of birth traumas and deaths still gives obstetrics in Uganda a bad rap. Grave shortcomings in maternity services are still the order of the day at various units, including but not limited to those in the GoU’s care. The failure to guarantee patient safety has led to a number of preventable deaths and injuries at a range of maternity units. The rise in medical mistakes has particularly been deeply disturbing, with a number of severe vaginal tears reported.
The GoU reckons that a new structure that was approved for health centre IIIs (HCIIIs) and health centre IVs (HCIVs) will considerably improve birth outcomes and experiences. Thanks to the new structure, up to 200 midwives will be added to the roster of national and regional referral hospitals. It’s not just the central-level institutions that are primed to get a much-needed tonic. Each of the country’s 146 districts is also set to get, on average, three midwives apiece. As noted earlier, this is commendable. The bump in the number of midwives should, however, not be treated as a magic wand.
Maternal and neonatal deaths in Uganda can be traced back to a range of other problems. Not just inadequate staffing. Weak leadership is writ large in Uganda. It has predisposed maternity services in the country to other attendant problems. Take, for one, the almost palpable lack of monitoring. The poor collaboration between clinicians can also be traced back to feebleness in leadership. A strong leadership would ensure there is openness, and it would, doubtlessly, actualise learning from medical mistakes.
With the proportion of caesarean section deliveries increasing, the country needs strong leadership now more than ever before. Caesarean section deliveries are known to present challenges by the truckload. Our leaders should be alive to such crucial yet seemingly ‘trivial’ details. Things like expectant mothers being heavier than ever before, older than ever before, point to changing demographics that must not be overlooked. Of course, the staffing vis-à-vis unmanageable workloads matter a great deal, too. The numbers say so. Last year, 2.2 million pregnancies were recorded in Uganda.
This represented an increase from the 1.5 million pregnancies recorded in 2023. More bodies are definitely needed in the maternity units. As is the leadership.
The GoU should outrightly resist the temptation to rest on its laurels, even as data shows that inroads are being made. The Uganda Demographic Health Survey 2022, for one, shows that maternal mortality declined to 189 deaths per 100,000 live births. In 2016, it was 336 deaths per 100,000 live births. All things considered, this is a telling drop. But look deeper and you will see that there is work to be done.