On a hot afternoon, the harsh sunlight cuts straight through the roof of Apuce Health Centre II in Ayami Sub-county, Lira District.
Outside the consultation room, a mother rests on the cemented floor, her baby curled tightly against her chest. Inside the Outpatient Department (OPD), the queue is frozen. Dozens of patients sit shoulder-to-shoulder on wooden desks meant for three people but crammed with five.
These mothers have travelled from as far as Apuce and Arwotomito parishes. Some walked for over an hour with infants strapped to their backs; others endured bumpy rides on boda bodas over rough murram roads. They wait patiently because, in this rural stretch of northern Uganda, there is simply nowhere else to go.
Established in 2012 to serve an isolated rural catchment area, Apuce Health Centre II has become a lifeline, handling between 750 and 800 clients every month.
The facility absorbs a massive regional health burden, offering critical services including:
HIV testing, counselling, and antiretroviral (ART) care
Tuberculosis (TB) diagnosis and treatment
Malaria prevention and management
Antenatal care (ANC) and family planning
Nutrition screening and laboratory services
Yet, for over a decade, the facility’s staffing levels failed to match the desperate community demand. The entire unit relies on just six staff members: three technical personnel (an assistant nursing officer, a health assistant, and a midwife) and three support staff.
Sister Lilly Epila, the assistant nursing officer in-charge, remembers the dark days when she had to run the facility single-handedly.
‘I was posted here in June 2015 to take full charge. From that time, I was working without a midwife,’ Sr. Epila recalls.
For a brief window between 2022 and 2023, a comprehensive enrolled nurse was posted to the facility. Because comprehensive nurses possess basic midwifery knowledge, Sr. Epila assigned her to antenatal care. “Pregnant mothers were crying because we were not palpating them,” she says.
However, the nurse was soon transferred, leaving the antenatal unit vacant once more. Pleas from the Health Centre Management Committee and Ayami Sub-county leadership to the District Health Officer (DHO) for a replacement initially fell on deaf ears.
The turning point came in early 2024 through an intervention by the Community Score Card (CSC)-a participatory social accountability tool commissioned by the Catalyzing Strengthened Policy Action for Healthy Diets and Resilience (CASCADE) project.
What is a Community Score Card? The CSC is an accountability tool that brings community members, local leaders, and service providers together to grade the quality of public services. By independently assessing indicators and holding dialogue sessions, communities can directly voice challenges, track solutions, and demand transparency. Under the CASCADE project, the CSC specifically targets health and nutrition outcomes.
The CSC assessment highlighted glaring gaps at Apuce HC II. Because there was no midwife, expectant mothers were shunning the facility, opting for traditional birth attendants instead. This directly contributed to poor maternal and child nutrition outcomes in the sub-county.
The data-driven advocacy worked. By September 2024, the district finally deployed an enrolled midwife, Ms. Judith Ajwang, to the facility. The score card dialogues also prompted the sub-county to connect the facility to electricity.
‘Right now, we have both the midwife and electricity,’ says a relieved Sr. Epila. ‘The power helps us attend to clients at night. When someone knocks at midnight, we are no longer scared because the light guarantees our safety. You step out with confidence.’
When this reporter visited Apuce Health Centre II, the newly deployed midwife, Ms. Judith Ajwang, was a blur of activity, methodically screening expectant mothers.
At the ANC unit, mothers undergo rigorous checks: Hemoglobin (HB) tests to catch anemia early, nutrition assessments using Mid-Upper Arm Circumference (MUAC) tape, and routine screenings for HIV, sickle cell, syphilis, and Hepatitis B.
‘On average, I see between 28 to 35 mothers daily. Since 2012, there was no proper midwife here, so we are still sensitizing the community that services are available,’ Ms Ajwang says.
Her efforts are yielding massive results. ‘When I drew up the annual work plan, my target was to register 200 new mothers for this financial year ending June 30. As of today, I have already registered 220. I am going beyond my target.’
For local residents, the impact is life-changing.
‘We used to travel to Aromo Health Centre III, which is about seven kilometers away, just for antenatal care,’ says Janet Akello, a mother of seven from Arwotomito Village. ‘Now that we have a midwife, the services have been brought closer to us.’
As a Health Centre II, Apuce is technically not accredited to conduct standard deliveries; its mandate is limited to ANC mapping, testing, and referring high-risk cases to larger units. However, reality often overrides policy. Ms. Ajwang has already had to perform two emergency deliveries since her arrival.
Despite the recent victories, the structural deficit remains alarming. Ms. Ajwang frequently operates in a “midwife alone” scenario-performing tasks meant for a team of nine. She simultaneously juggles antenatal care, family planning, postnatal checkups, and diagnostic testing.
While the health centre is currently transitioning to digital documentation using tablets to improve data tracking, healthcare experts warn that technological upgrades cannot replace human resource shortfalls. For Apuce HC II to fully guarantee patient safety, the district must move swiftly to bridge the critical staffing ceiling gaps that still hold this rural community hostage.