Unsafe Abortion:Health advocates drag Uganda’s Parliament to Court

By Beatrice Nyangoma

Dr. Charles Kiggundu a Senior gynacologist at Mulago National Referral hospital sees atleast 15 women who have undergone unsafe abortion. These are as young as 9 and 15 years and as old as 40 years.

He says that these have various reasons why they decide to terminate pregnancies.

“I have a university student who has been impregnanted five times by her father and she has procured abortion five times. Many girls opt to terminate pregnancies that are as a result of incest and rape.”he says

He says that as much as this girl can afford to have a safe abortion, many of the others use rudimentsry means to terminate pregnancies.

Dr. Kiggundu emphasises that lack of a clear legislation in Uganda has led to many girls and women procuring unsafe abortion most of whom resulting into deaths.

“Unsafe Abortion continues to constitute a serious public health, human rights and social equity issue that affects millions of women in sub – Saharan Africa, and causes 29,000 deaths annually.”he says

“Women of all social standings seek abortion services, but it is mostly young women and poor women who die or suffer long term consequences from unsafe abortion due to the severe socio-economic deprivation they encounter. Providing access to safe abortion is a critical step towards reducing the unacceptably high rates of maternal death in Africa.” Kiggundu notes  

According to World Health Organisation, of the 6.4 million abortions in Africa carried out in 2008, only 3% were safe. One quarter of unsafe abortions occurred among adolescents aged 15-19, and 60% were among women under age 25. Additionally, unsafe abortion accounts for 13% of global maternal deaths and up to 40% of maternal mortality in African countries.  

Meanwhile, Uganda has one of the highest rates of unsafe abortion in Eastern Africa. It is a leading cause of maternal morbidity and mortality in the country, contributing to approximately 26% of the estimated 6,000 maternal deaths every year, and the estimated 40% of admissions for emergency obstetric care. Unsafe abortion places a huge cost on the public health system; approximately Ushs 7.5 billion are spent annually to treat complications.

A national abortion incidence study found that 15 out of every 1,000 Ugandan women of reproductive age were treated for abortion complications in 2003. Poor, rural women are at increased risk of unsafe abortion, 68–75% experienced complications, compared with the 17% complication rate for non-poor urban women.

According to Kiggundu, Uganda’s restrictive abortion laws permits abortion only to save the life of a pregnant woman. However, conflicting and restrictive interpretations of the abortion provisions under the 1995 Constitution of Uganda, the Penal Code Act and National Reproductive Health Policies have created confusion about the correct legal status of abortion.

According to a study conducted by Human Rights Awareness and Promotion Forum- HRAPF between 2011 and 2015, in seven main police station in Kampala, atleast four people were arrested every year in relation to abortion. Linette du Toit, the Research and Advocacy Officer at HRAPF says that nationally 182 arrests were made on abortion charges noting that few of the health workers are arrested.

Its a gainst this background, that  Prof. Ben Twinomujuni a Law don at Makerere University together with Center for Human Rights and Development-CEHURD filed a petitioned seeking that the constitutional court  orders the Executive and Legislative arms of government to pass a law  regulating termination of pregnancies to reduce maternal mortality rates that arise from  unsafe abortions.

The law dons in their petition filed on March 3 2017, contend that the existing legislation only permits abortion in exceptional circumstances such as a life of a mother at risk, but doesn’t protect young girls and married women who may get unwanted pregnancies hence resorting to unsafe abortion methods.

The petitioners argue that other African countries like Kenya, Rwanda, Ethiopia, Ghana and Tunisia, which are similar in social and economic circumstances as Uganda, deliberately developed laws to protect the rights of women by prescribing circumstances under which a woman is allowed to terminate her pregnancy.

“We do not see any reason as to why Uganda should not borrow a leaf from its neighbours and take an essential step to   protect the lives of women who continue dying day by day due to unsafe abortions,” reads part of the petition.

“Because the government has not operationalized Article 22(2) of the 1995 constitution of Uganda as a way of clarifying the parameters for legal abortion, healthcare providers are unable to provide safe and legal abortion services, while law enforcement officials and judicial officers do not effectively enforce or implement laws that permit abortion thus denying women and girls access to safe and legal abortion services.”Twinomujuni notes

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Access to SRH Commodities for women still a challenge- Report

Christine Nagasha, (23) a resident of Isingiro district dropped out of school while in senior two after she realized that she was pregnant. The man responsible for her pregnancy, who was also her schoolmate disowned the pregnancy leaving her in a dilemma. Going back home, her parents threw her out of the house asking that she goes to the person responsible for the pregnancy to take care of her.

Nagasha was left homeless with no one to run to so she resorted to sleeping in churches with no food to eat.

“I would move from household to another to get petty jobs, but people were also not paying me while my status was also affecting my health since I was not having regular meals. By the time I was due for labour, I had nothing to use so some midwives abandoned me for other mothers who had the requirements.” she narrates

Nagasha notes that one of the elderly midwives in the hospital identified her struggles and she purchased some items such as a kaveera, cotton wool and some baby clothes.

“After giving birth I stayed in the hospital despite being discharged because I had nowhere to go. After one month, a good samaritan took me on as one of her children and that’s how I survived.” she says

Nagasha notes that she regrets the pregnancy because it frustrated her education and yet the boy who was responsible for the pregnancy continues with schooling.

This case contributes to the statistics where thousands of girls drop out of school because of unwanted pregnancies. From the 24% in the previous surveys, the 2016 Uganda Demographic Health Survey put teenage pregnancy at 25%. Thus a slight increase in a statistic that’s already amongst the highest in sub-Saharan Africa. This means 1 in every 4 girls aged between 15-19 years in Uganda is either pregnant or already having their first baby.

Nagasha wishes she had known about family planning to protect herself from such a situation. “I would like to appeal to government to ensure that the girls are educated about their sexuality and how they can stay in school without pregnancies. The midwives in hospitals should also understand that some girls are abandoned by their parents and relatives and so go into labour without the requirements.” She appeals

Although she is aware of the different Family planning commodities that she can choose from to avoid another unwanted pregnancy, she couldn’t get a long term method from her nearest health facility.

Nagasha shared her story during the women’s day pre-event press conference at Imperial Royale hotel in Kampala. The conference was convened by Health Systems Advocacy project partners which include HEPS-Uganda, ACHEST and Amref Health Africa.

The press conference was aimed at launching a survey report on accessibility, affordability and availability of Sexual Reproductive Health Commodities in 124 public, private and Mission hospitals.

According to Denis Kibira, the Executive Director HEPS-Uganda noted that the survey results indicated frequent stock-outs of SRH commodities especially long term family planing methods were highly demanded but unavailable in the public facilities.

“In general, SRHC availability was inconsistent. Birth control pills were available in only 47% of facilities. Also, contraceptives were generally more commonly available in the public sector than in other sectors: injectable contraceptive, the most commonly used contraceptive in Uganda, was available in 86% of public sector facilities, but only available in 57% private and 25% of mission sector facilities.” he noted

The survey also indicates that stock-outs were quite common in the public sector (12%), and lasted on average almost 20 days per month while in the public sector specific SRH Commodities were stocked-out at up to 36% of all facilities.

“The suboptimal availability of contraceptives makes it difficult to access the commodities, which likely contributes to the about 30% of women in Uganda who were experiencing unmet needs for family planning in 2015.” Kibira noted

The 2016 Uganda Health Demographic Survey-UDHS indicated that maternal mortality has reduced from 438 to 368 deaths per 100,000 live births. However, according to Kibira, the survey indicates rampant stockouts of Magnesium Sulphate, a drug prescribed for pregnant mothers with onset of high blood pressure, also called pre-eclampsia, one of the leading causes of maternal deaths.

He also adds that there is inconsistent availability of other pregnancy drugs such as dexamethasone, used in the management of preterm labour whose availability was also low in the public at 36%, private 55% and mission 43%.

“Oxytocin, used to induce labour and in the prevention and treatment of post-partum haemorrhage, was commonly available in the public sector (90%) but less commonly available in the private and mission sectors. Misoprostol, also used to induce labour, was commonly available in the public sector (88%) but less common in the private and mission sectors (50%and 55% respectively.” he said

Dr. Patrick Kagurusi from Amref Health Uganda said that the government needs to review the budget for SRH services.

“The Ugandan government should increase its budget allocation for the purchase of sexual reproductive health commodities.  Specifically, the Ministry of Finance, Planning and Economic Development (MoFPED) must avert future stock-outs through increased budget allocations for sexual reproductive health commodities to Increase affordability and availability of reproductive health commodities to all persons in the reproductive age group. Measures to avoid delayed financial disbursements that contribute to stock-outs of all commodities must also be considered.” he noted

Paul Gabula of ACHEST notes that the government needs to retain the health workforce such that long term family planning methods can easily be administered to those in need.

The report also indicates that staffing is especially challenging in remote, rural areas, where some facilities have less than 30 percent of positions filled.

“Attracting and retaining skilled health workers continues to be a challenge for the government-led health sector in Uganda; according to the 2015/16 annual sector performance report, only 71 percent of approved positions have been filled.” he said

Why female health workers do not trust their public workplaces with their babies

Sister Carol (not real name) has been working in the paediatric clinic in one of the hospitals in central Uganda.

Carol wants her true identity to stay hidden if she is to talk to me freely, because she is afraid for her job. Before being transferred to the paediatrics department, Carol had been working as a midwife for more than five years at the hospital, starting immediately after her midwifery course.

It is also during this time that she met the love of her life and decided to start a family. Carol took her antenatal care from the same hospital since she was confident of her work colleagues, and trusted the hospital work.

“My husband and I decided to get our services from here, because [we felt] if I was not confident of the system I was serving, then I was not worthy to be called a service provider. We talked about it and decided I would deliver our first child from this hospital. In any case, we had no alternative; we couldn’t afford private services,” she says.

US-army-doctor-attending-to-a-childinternet photo

When she was eight months pregnant, Carol took her ‘mama kit’ suitcase into the midwives’ room at the hospital, just in case.

“What I did not do was book a doctor who would work on me. Something I regret up to now. I arrived at the hospital in labour on a Wednesday evening and everything happened so fast. One of my colleagues, a nurse was taking her ward rounds when I arrived. My husband was still at work so I was all alone at the hospital,” she remembers.

With the labour pains intensifying, Carol could not get a doctor immediately. Her colleague was trying to call for help too, but in vain.

“Being a midwife, I knew what to do and yes, I started pushing. Since the doctor my colleague had contacted had promised to arrive shortly, I knew it was now upon me to [step in for myself] until the doctor arrived. But he never showed up ‘shortly’; by the time he did, it was too late. The baby was halfway out and it had suffocated because I delayed,” she says, in tears.

Carol says although she had been reading stories of mothers and babies dying due to neglect, it had never occurred to her that she could be a victim.

Lightning strikes twice

“Being a very religious couple, we prayed about it and decided not to blame anyone but to try again,” she notes.

Six months later, Carol conceived again and the couple again chose to deliver at the same facility.

“This time I talked to one of my close colleagues and asked them to be around whenever I would be due. But then, the baby came sooner than we expected, at seven months. It was 2am when I felt labour pains. I thought it was just false pains, so I just walked to the hospital like any expectant mother, to have a checkup,” she says.

“I don’t know how I did not see this coming, yet I had examined so many mothers who would have premature babies. Whereas I would refer such mothers to bigger hospitals, it was too late for me. The baby was coming and my hospital did not have incubators. I looked on; no ambulance to rush me to the next hospital. My husband was upcountry.”

Again, in the hospital where Carol had served with diligence, she lost her baby under avoidable circumstances. She had to undergo a caesarian section birth to remove the dead foetus and save her life.

“The hospital I had served for so long had failed me in my desire to have children. When my husband got the news, it was devastating. We decided not to have any more kids until we were financially stable to foot medical bills in a private facility,” she says.

Pregnant-WomanAfter losing two babies from a hospital where she has served for more than seven years, ushering thousands of mothers into the family way, Carol lost trust in the services offered by her employer.

“I filed my complaints to the district health monitoring unit and also to the ministry of health. But I only received promises, especially from the district health service commission, of how they were going to investigate the circumstances under which I had lost my babies,” she adds.

At one point, Carol contemplated quitting her job.

“I trusted the system of which I am part, so much. I thought the government was providing good services and the patients were just good at not appreciating. But after my experience, I realized I was wrong and thought of leaving the system completely; how would the patients trust my services after my experience?” she ponders.

Do as I say…

Carol’s story relates to so many female health workers who opt for private health facilities for their own maternal health needs. Dr Sarah Ogobi, the in-charge Luwero Health Center IV, says government should devise a system that allows female health workers to access decent maternity services.

“When I was going to give birth to my second child, I had been posted here as an in-charge for three years. I wondered how I was going to have my child at this health center where I knew I had no access to a gynaecologist. Our ambulance is rarely functional, because of fuel and sometimes it has mechanical issues,” she says.

Ogobi says she could not imagine herself going through what other mothers do when they seek maternal health services from the health center she manages.

“It is terrible! Sometimes you look at a mother and you almost shed tears because you cannot help her even when you badly want too. Sometimes we have no power, no drugs, no referral means and in such situations, the health workers do what is in their power; if God wills and the baby and mother survive, we are happy,” she says.

Ogobi chose to have her baby in Mulago National Referral hospital’s private wing.

Even then, “I had to pay Shs 600,000 for a normal delivery, with no consideration that I was a medical doctor.”

She wants government to expedite health insurance for female health workers, who have to regularly seek expensive reproductive health services that their own points of service cannot give them.

“I had to part with more than half of my miserable pay to have a child. I had to run away from my own health center that I manage, because I was afraid I could have complications that may not be managed.”

Sister Ezeresi Nannyanja, the Deputy Principle Nursing Officer at Nakaseke hospital says apart from the general demands that need to be addressed by the government, there is need to prioritize female health workers.

“I gave birth to all my children at Mengo hospital where I was working then, because I trusted the services. In fact, health workers are not even charged for maternity services at the hospital, something that not only motivates the workers, but also builds trust among other clients, because we use our own services,” she says.

Mengo hospital is a private hospital run by the Church of Uganda. The same cannot be said of many public healthcare facilities, where drugs, essentials and staffing are not readily available.

Nannyanga says the female health workers at Nakaseke hospital prefer to give birth at private health facilities than the district hospital.

“And the reasons are valid; our doctors are never here, especially in the night even when they have staff houses. But we understand that their pay is miserable and therefore they have to find other jobs to fill the financial gap,” she says.

The female health practitioners’ concerns come during a national health workers’ strike, under their umbrella Uganda Medical Association, demanding better pay and better working conditions. The health workers want enhanced allowances for overtime, housing, transport, medical risk, and retention, among other demands.

This article was also published in the Weekly Observer: http://observer.ug/lifestyle/56117-why-female-health-workers-do-not-trust-their-public-workplaces-with-their-babies.html

 

I attempted suicide eight times after testing HIV positive-Beauty Queen

By Beatrice Nyangoma

There is no easy time to any one as a time when one tests HIV/AIDS positive. In fact one of the first thoughts that come to one’s mind is death! One thinks that they are dead or about to die but they are just buying time.

Martha Clara Nakato 21, tried unsuccessfully to commit suicide eight times after she tested HIV positive at the age of 14. Whereas most people go for testing after having unprotected sex, Clara was still a virgin, in fact she tested having accompanied her twin brother who had had several unprotected sexual encounters and felt at risk.

“My twin brother Wasswa asked me to accompany him for an HIV test, at my age I did not find it really important to test because I was still a virgin and I mean I did not have any information on HIV. But you know, as a teenager, I was inquisitive and just wanted to go through what my twin brother was so I took the test that we both at the same time.” she narrates

As the twins waited for the results, Martha was strong because she expected the obvious results, there was no way her results could turn out positive.

“I was instead feeling nervous on behalf of my brother. At that time Wasswa was not even talking to me, he was shivering. He started telling me the girls she had slept with and those he suspects could have infected him in case the results came out positive, I felt pity for him.” she adds

Results coming out, Nakato was found HIV positive instead and her twin brother Wasswa was negative. “I told the nurse that there was a mistake, it’s my brother who is positive and not me. The nurse meant what she was telling me! It was true; I was positive of HIV/AIDS.” she added.

But how did Martha get infected?

“The health facility from which we tested was near our home and our dad was known to most of the facility staff. I requested the nurse to take me home because all I could think about was going to a high way and get knocked by a vehicle, but I wanted my father to know my status first.”

Nakato with the company of her brother and the nurse broke the news to her father. He was however furious at the nurse who made HIV/AIDS tests on her children without his consent and he even threatened to take a legal action against the health facility.

She was instead confused as the only person whom she expected to understand her situation was not helping either. “I mean, I knew nothing about sex, I was still a virgin and am tested positive and the only person who I expected to stand with and support me was instead angry that I knew my status.” she says

That evening, Nakato went to a shop and bought rat poison to end her life because she had no one left to listen to her problems but also she felt  dead anyway.

Nakato was however unsuccessful after she was rushed for medical attention before it would have any impact on her.

Her father would the following day tell her how she was born with the HIV virus and that her mother had died of HIV as opposed to lung cancer like they claimed.

“Growing up we knew that our mother had died of lung cancer but it wasn’t until I tested HIV positive that my father spoke the truth. The doctors were able to prevent the virus from passing on from my mother to my twin brother but it was the case for me because I came two hours later.” she says

Having known how she acquired the virus, Nakato did not want to go through the long term ailment like her mother and so she tried several means of ending her life. From over drinking alcohol, to jumping from buildings to drowning herself in a swimming pool but unsuccessfully.

But how did she reach 14 years without falling sick like many other children born with the virus?

“I happen to come from a well to do family where we had a family doctor who would be there in case of any ailment. So it was very hard to know what I was suffering from because my job was to only take the medicines given to me without knowing what exactly I was taking.”she notes

Her father also told her that she had been taking Septrine since her childhood as one of the medication for the virus.

Nakato’s father later took her to Kamwokya Caring Community where she used to pick her medication. From there she started interacting with the people in her same category and learnt how to move on positively.

However, Nakato recalls that the biggest challenge was at school she would regularly falling sick and would miss classes.

“I told some of my close friends at school about my status and they instead spread the word around the school. Everyone was looking at me as a walking dead person. I felt like leaving school and wait for my day to die since I  had attempted to commit suicide for eight times and I was unsuccessful.”

Nakato was forced to change to a day school because she needed frequent medical attention and she couldn’t handle the stigma at the boarding school.

In 2014, while in senior six, Nakato was introduced to The Aids Support Organization-TASO from where she got a different picture to life.

“I met my age mates who were going through situations that were worse than mine. Some of them had lived  reckless lives but they were positive towards life. They were adherent to the drugs, they studied what the disease they are living with requires and they were making changes in society. I was inspired, and since then I have preached about HIV/AIDS with evidence.” she says beaming with a smile

In her advocacy work, Nakato has met thousands of youth in schools and tertiary institutions to sensitize them on HIV/AIDS.

“I joined music, dance and drama clubs and last year I contested for the Young positives beauty pageant and I was voted as the queen for the central region. This pageant has taken me to places and I have also inspired more young positive girls to look at life differently. I hope to do more work after I complete my bachelors’ course at Kyambogo university.” she adds

Nakato appeals to the government to construct or gazette youth friendly corners in health facilities so that they get the right counseling about HIV.

“I think I attempted suicide because I had no one to talk to me before and after testing. This is a component missing in our health facilities that a 15 year old will wait from the same health Centre reception with a 40 year old and both will be attended by the same person and yet these two age groups have different information needs.” Nakato says

The Uganda Population-Based HIV Impact Assessment (UPHIA) national survey conducted in August 2016 and March this, the prevalence of HIV among adults aged 15 and 64 in Uganda is 6.2%.

The survey also indicates a prevalence of 0.5% prevalence among children aged 0-14 years which is about 95,000 children living with HIV. It also reveals that among the young adults, there is a disparity in HIV prevalence by sex. HIV is almost four times higher among females than males aged 15-24 years.

Kisoro district Teenage pregnancy rates alarming

By Beatrice Nyangoma

Immaculate Akankwasa 19, a resident of Karumere village, Kisoro town council in Kisoro district vividly recalls the day she went to hospital for a pregnancy test and she was found positive. At the age of 14 years, Immaculate had her dreams of being a nurse washed away. She could not be allowed to sit her Primary Level Education examinations and so she moved in with the father of the pregnancy.

“My parents forced the man responsible for the pregnancy to marry me and take care of me. After giving birth, the man asked me to go back to school and that he would be paying for my school fees. But when I reached senior two, he told me that he was tired of paying and he suggested that I sit home as he takes care of me.” she says.

Akankwasa would later get her second pregnancy unexpectedly because she had wanted to quit the marriage because the man had started mistreating her.

“I had started doing petty jobs like washing clothes for people in the village and I was planning to go back to my parents but then I realized I was pregnant again. Two months after giving birth, the man chased me from the house and I was left homeless with two children.” she says

Akankwasa is one of the girls that contribute to the statistics recorded by the Kisoro hospital every month of teenagers carry unwanted pregnancies.

According to Annie Modesta Budongo, the in-charge of the women’s ward at Kisoro hospital, the hospitals records an average of two girls who show up at the facility to get maternity services. She adds that every month the hospital records at least one case of botched abortion.

“We get girls as young as 13 years who come for antenatal services while others come seeking ways of getting the pregnancies terminated.” she says

In the month of July this year, Kisoro hospital recorded 250 deliveries out of which 61 were mothers aged between 10 and 19 years while 50 of a total of 256 deliveries were reported in September.

Francis Munyarubanza, the Kisoro district Education Officer notes that teenage pregnancies have increased the number of girls dropping out of school.

He notes that out of the 11,000 girls that enrolled in primary one in 2010, only 2,234 sat for the Primary Leaving Examinations meaning over 8,000 girls had dropped out.

“We don’t know what to do when it comes to teenage pregnancies. Whereas some girls drop out because of finances, the general picture shows that the highest percentage drop out because of unwanted pregnancies.” he notes

The situation is not unique to Kisoro district as Kabale teenage pregnancy statistics are equally alarming.

According to Mandera Immaculate, the Acting District Health officer, the district recorded 2,264 girls between the age of 10 and 19 out of the 15,278 women who went for antenatal services which is 14.8%.

Mandera notes that 1,637 teenage girls delivered from the public health facilities out of a total of 10,510 mothers which is 15.7%. In the same year 2015/16, 1,461 teenage girls sought for family planning services out of the 18,723 clients registered at health facilities which 7.8%.

Contraceptives an option?

On 29th September, the ministry of health rejected to launch revised guidelines that would see teenage girls access to contraceptives from public health facilities on grounds that the ministry had not made enough consultations with the stakeholders.

Budongo notes that even in the absence of approved guidelines by the ministry, she still gets cases where girls seek emergency pills. She adds that although she issues the contraceptives to them, she fears that she does this putting her job at risk.

“I am human too and a parent. I don’t feel comfortable when I deny such a girl in need contraception to secure her future. But I know the ministry has no policy for that and the only way explanation I can have in defense is that the family planning registration book has provision where we can record the teenagers.” she says

However, Ruzaza Christopher, the health services coordinator at the Diocese of Buhabura notes that the ministry of health officials should not pretend that they do not see what is happening in the country. He notes that the longer the government delays to launch the guidelines the more girls will drop out of school because of unwanted pregnancies.

“Let us put other factors aside and allow the girls who cannot abstain from sex to have access to contraceptives instead of letting them drop out of school. There is nothing as bad as a child growing up knowing that he/she was an unwanted child.” he says

He adds that the health ministry only needs to package the information well so that the girls know the side effects of contraceptives and how they risk getting infected by HIV.

Ruzaza however notes that the government needs to invest more in family planning commodities at health facilities if the policy is going to be effective.

“We already have an unmet need for contraceptives as a nation. This implies that if we are to have that provision for the teenagers, we need to double the supply.” he adds.

Dr. Stephen Nsabiyumva the Kisoro District Health Officer notes that the policy on contraceptives for teenage girls has been delayed. He says that the ministry of health has the mandate to ensure that the girls are not impregnated by provision of youth friendly services including contraception.

“Regardless of religion, culture and morality, we need the contraceptives urgently. We cannot continue looking at our girls dropping out of school and ending up in miserable lives and yet we can do something to prevent this.” he said

However, his education counterpart Runyabuzanza disagrees saying that this is likely to lead to more moral decay among the girls.

“I think we need a comprehensive policy on parenting. Giving girls contraceptives will just worsen the situation. Yes the statistics are alarming but contraceptives are not the solution. Let the ministry look at the other drivers of sexual promiscuity and address them as a whole.” he said

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Improving skills of mid wives, the easy way

Every person who has a career has desire to improve his/ her skills through further training. However, the thought of abandoning the family and sometimes taking study leave, which is rarely approved by the employers makes career advancement difficult.

However, in in Uganda, over 700 midwives will acquire skills from wherever they are, courtesy of a funding by GSK through Amref Health Africa.

The project coordinated by Amref Health Africa and funded by GSK is worth 250,000 pounds between 2015 to 2020 targets at increasing the number of the midwives at lower health centers and also improve their skills.

Andrew Wabwire, the E-learning project coordinator at Amref health Africa, says that the project targets midwives who are already working and cannot get study leave. He notes that the project targets the midwives from their local areas.

“We have midwives who are willing to enhance their skills but they are not able to obtain study leave from their employers while others have families and cannot go to school every day. So with this project we aim at targeting midwives who are working in hospitals that also have medical schools.” he says

The funding will be used to procure ICT equipment for the hospitals, medical schools and training the tutors. The nursing and midwifery schools to benefit include Mulago, Nsambya, Mengo,, Soroti, Lubaga, Arua, Kagando, Masaka, Jinja, Public Health Nurses College-Kyambogo, Kabale, Kagando and Lira.

However, according to Mrs. Meryce Mutyaba, the Principal Tutor at Mengo School of Nursing and Midwifery notes that the ministry of education needs to increase on the number of tutors if this project is to be successful.

She notes that the number of midwifery students at the school has increased over the years and yet the number of tutors remains the same.

“It is difficult to manage full time students and at the same time monitor those on e-learning. The education ministry recommends a ratio of 1 tutor per 30 students, but here at Mengo we are as high as 1:70. This compromise the quality time a tutors would be spending with each student.” She adds

Mutyaba notes that whereas the project will ensure that the health centers have skilled work force, there is need for the education ministry to streamline career guidance to address attitude issues which have left many mothers and babies die on the wards because of careless midwives.

“Midwifery is a calling. One has to love their job before anything else. Someone can have the training and skills but when they have a poor attitude towards work, they will not perform, and therefore students have to be mentored before enrolling.” she said

Sam Mbowa, the GSK Uganda, French and East Africa manager notes that the government should ensure that the trained midwives do not leave Uganda for greener pastures.

“This is a huge investment into the health sector and therefore we have to provide resources and motivate the midwives to stay and work from here.” he says

Uganda is a signatory to the Africa Medical Councils protocol on health workforce immigration that was signed in 2016. The protocol is aimed at managing the immigration of health workforce both internally and externally.However, according to the registrar for the Uganda Medical and Dental Practitioners Council, Dr. Katumba Ssentongo, the process of implementing the protocol in Uganda has been slow because the council is understaffed.

“We have done some work in line with the protocol but the not as much as the pace our counterparts are moving. We have less staff and thus we only do that which is within our means.” he said

 

 

 

 

 

 

 

 

 

 

Teenage pregnancies and the contraceptives debate, the girls stand to lose with no decision

By Beatrice Nyangoma

Immaculate Akankwasa 19, a resident of Karumere village, Kisoro town council in Kisoro district vividly recalls the day she went to hospital for a pregnancy test and she was found positive.

At the age of 14 years, Immaculate had her dreams of being a nurse washed away. She could not be allowed to sit her Primary Level Education examinations and she was married off to the father of the pregnancy.

“My parents forced the man responsible for the pregnancy to marry me and take care of me. After giving birth, the man asked me to go back to school and that he would be paying for my school fees. But when I reached senior two, he told me that he was tired of paying and he suggested that I sit home as he takes care of me.” she says.

Akankwasa would later get her second pregnancy unexpectedly because she had wanted to quit the marriage because the man had started mistreating her.

“I had started doing petty jobs like washing clothes for people in the village and I was planning to go back to my parents but then I realized I was pregnant again. Two months after giving birth, the man chased me from the house and I was left homeless with two children.” she says

Akankwasa regrets having left school because of a man she thought would love her forever. she wishes she could turn back the time to make better decision of staying in school.

Annie Modesta Budongo, the in-charge of the women’s ward at Kisoro hospital says that at least two girls show up at the ward seeking maternity services everyday . She adds that every month the hospital records at least one case of  a teenager seeking for abortion or has aborted else where unsuccessfully.

“We get girls as young as 13 years who come for antenatal services while others come seeking ways of getting the pregnancies terminated.” she says

In the month of July this year, Kisoro hospital recorded 250 deliveries out of which 61 were mothers aged between 10 and 19 years while 50 teenagers out of 256 deliveries were recorded in September.

Francis Munyarubanza, the Kisoro district Education Officer notes that teenage pregnancies have increased the number of girls dropping out of school.

He notes that out of the 11,000 girls that enrolled in primary one in 2010, only 2,234 registered for the Primary Leaving Examinations in 2017 meaning over 8,000 girls had dropped out.

“We don’t know what to do when it comes to teenage pregnancies. Whereas some girls drop out because of finances, the general picture shows that the highest percentage drop out because of unwanted pregnancies.” he notes

The situation is not unique to Kisoro district as Kabale teenage pregnancy statistics are equally alarming.

According to Mandera Immaculate, the Acting District Health officer, the district recorded 2,264 girls between the age of 10 and 19 out of the 15,278 women who went for antenatal services which is 14.8% in 2015/2016.

Mandera notes that 1,637 teenage girls delivered from the public health facilities out of a total of 10,510 mothers which is 15.7%. In the same year, 1,461 teenage girls sought for family planning services out of the 18,723 clients registered at health facilities which 7.8%.

Contraceptives an option?

Budongo notes that even in the absence of approved guidelines by the ministry, she still gets cases where girls seek emergency pills. She adds that although she issues the contraceptives to them, she fears that she does this putting her job at risk.

“I am human too and a parent. I don’t feel comfortable when I deny such a girl in need contraception to secure her future. But I know the ministry has no policy for that and the only way explanation I can have in defense is that the family planning registration book has provision where we can record the teenagers.” she says

On 29th September, the Ministry of Health rejected to launch revised guidelines that would see teenage girls access to contraceptives from public health facilities on grounds that the ministry had not made enough consultations with the stakeholders.

Prof. Anthony Mbonye, the Director General of Health at the Health Ministry during the second national conference on unsafe abortion informed the participants that the ministers withheld the guidelines on grounds that they were approved by junior officers. He however noted that he strongly believes that girls should have access to contraceptives.

“I strongly believe, and they can fire me because of my opinion but I strongly believe that the adolescents should get access to contraceptives! In Uganda women of reproductive age have access to contraceptives. It doesn’t mean that we go to their homes and churches to distribute them.”he said

However, Ruzaza Christopher, the Health Services Coordinator at the Diocese of Buhabura notes that the ministry of health officials should not pretend that they do not see what is happening in the country. He notes that the longer the government delays to launch the guidelines the more girls will drop out of school because of unwanted pregnancies.

“Let us put other factors aside and allow the girls who cannot abstain from sex to have access to contraceptives instead of letting them drop out of school. There is nothing as bad as a child growing up knowing that he/she was an unwanted child.” he says

He adds that the health ministry only needs to package the information well so that the girls know the side effects of contraceptives and how they risk getting infected by HIV.

Ruzaza however notes that the government needs to invest more in family planning commodities at health facilities if the policy is going to be effective.

“We already have an unmet need for contraceptives as a nation. This implies that if we are to have that provision for the teenagers, we need to double the supply.” he adds.

Dr. Stephen Nsabiyumva the Kisoro District Health Officer notes that the policy on contraceptives for teenage girls has been delayed. He says that the ministry  has the mandate to ensure that the girls are not impregnated by provision of youth friendly services including contraception.

“Regardless of religion, culture and morality, we need the contraceptives urgently. We cannot continue looking at our girls dropping out of school and ending up in miserable lives and yet we can do something to prevent this.” he said

However, his education counterpart Runyabuzanza disagrees saying that this is likely to lead to more moral decay among the girls.

“I think we need a comprehensive policy on parenting. Giving girls contraceptives will just worsen the situation. Yes the statistics are alarming but contraceptives are not the solution. Let the ministry look at the other drivers of sexual promiscuity and address them as a whole.” he said

The newly released data from the Uganda Demographic and Health Survey 2016 (UDHS) conducted by the Uganda Bureau of Statistics between June 12 and December 18, 2016, indicate a 1 per cent increase in teenage pregnancy from 24 per cent in 2011 to 25 per in 2016.

The report indicates that Teso sub-region has the most numbers of childbearing adolescent girls, standing at 31 per cent, and Kigezi sub-region with the lowest at 16 per cent. Tooro, Bunyoro and north-central sub-regions also have high levels of teenage pregnancy, standing at 30, 29, 30 per cent respectively while Kampala City registered the lowest rate of teenage pregnancy at only 17 per cent.

 

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Jinja hospital mental health department understaffed

Sarah Mudondo, a resident of Namayingo district has been taking care of her 24 year old son who suffers from mental illness. Her son has been admitted at Jinja Regional Referral hospital for over one month now. Mudondo says that she spends more than Shillings 20,000 on drugs and food daily.

 “I have spent over four weeks here but am now failing to manage looking after the patient because i have to spend at least 20,000 shillings to buy drugs and food. Most of the prescribed drugs are out of stock here. So the only option is to buy.” she says

Edith Alitwala, a senior Nursing Officer in the Psychiatry Department, says there are only four nurses instead of 8. 

 According to Alitwala, the number of mental health patients has almost doubled in the previous three months. She explains that they used to receive between 20 and 30 patients daily, but the number has increased to over 60 patients.

Alitwala also notes that the unit is faced with a challenge of essential drug stockouts, adding that sometimes the unit  spends over two years without receiving Phenytoin and Injectable Fluphenzine, the two most essential drugs for mental illness.

Alitwala emphasizes that the failure by the hospital to provide meals to the patients is a big setback. She says that in most cases they are forced to suspend medication to patients especially with HIV when they learn that the patient has not eaten.

 She also cited insecurity as another challenge in the hospital. The mental health unit relies on the guards at the main gate, which is a very long distance from the unit.

“We have two nurses on night duty and there is a time when a patient wanted to strangle a nurse.  They had had to call security personnel at the main entrance, which is very risky.”she said.

 The Mental health department of Jinja Regional Referral Hospital was established in 2010 following the decentralization of mental healthcare to regional referral hospitals to reduce at Butabika Referral Hospital.

Experts task government to prioritize reproductive health needs for teenage girls

On the International Day of the Girl Child, a network of Ugandan society groups, health workers, young people, and other concerned citizens harshly criticized a decision by Ministry of Health executive leadership to halt the release of the Sexual and Reproductive Health and Rights Guidelines and Service Standards.

Last month, the state minister for primary health Joyce Moriku at the closing ceremony of family planning conference declined to launch the national guidelines and service standards for sexual and reproductive health and rights noting that stakeholders had been involved in the compilation of the guidelines.

Now the civil society have tasked the ministry to release the guidelines in a bid to reduce the teenage pregnancies.

According to the 2016 Uganda Demographic Health Survey 25% of adolescent girls and young women aged 15-19 in Uganda is pregnant or a mother, one of the highest teenage pregnancy rates in sub-Saharan Africa. Shockingly, this statistic has remained unchanged since 2006, despite massive funding by donor governments in reproductive health services.

Denis JJuuko the program officer for CEHURD,  notes that there is a big In Uganda, teenage pregnancy has drastic and far-reaching health, development, and economic affects at the individual, family, community and national levels. These include preventable death in childbirth, high risk of unsafe abortion, lack of access to education, poverty, lost economic growth, and more. Despite the catastrophic consequences of teen pregnancy, Ministry of Health has not only failed to invest in interventions that work, but also is fixated on thwarting actions that drive life saving services even further out of the hands of young women.

“Upon rejecting the guidelines, which are designed to focus attention on the services delivery needs of young women and girls agenda 15-19, Ministry of Health officials made inaccurate claims, for example that they “had not been consulted” and that the Guidelines intended to distribute contraceptives to 10 year olds.” said Patrick Mwesigye, the team leader for Uganda outh and Adolescent Health Forum

Experts pointed out that sexual activity among Ugandan teenage girls is an issue that the Ministry of Health has refused to address with evidence-based responses.

“Instead of ensuring a robust policy environment based on human rights and community needs, there is a policy desert. This must stop. We have to address the reality Ugandan girls are facing. These actions are making life for Ugandans more dangerous, by tying the hands of our policy makers and health workers. We need access to services based on science and evidence, and that includes sexual and reproductive health services such as Pre Exposure Prophylaxis for HIV prevention, contraception, and more for young people who are sexually active,” Jjuuko noted

Uganda’s rate of maternal mortality and morbidity due to unsafe abortion is higher than the regional average, and teenagers are at particularly high risk of complications from unsafe abortion—due to stigma, fear, isolation and criminalization.

This abrupt reversal is not the first of its type—Coalition members pointed to the ban on Comprehensive Sexuality Education announced in 2016, as well as the withdraw in 2015 of the Standards and Guidelines on Prevention of Maternal Mortality Due to Unsafe Abortion as part of an alarming trend in top Ministry of Health management sabotaging evidence based policies and approaches to prevent unnecessary suffering and death. Infighting and attacks among Executive Management has also created distraction from core work and demoralization among staff.

 

Empowering Girls in Emergencies is Crucial to their Survival- Save the Children

Press Release

On October 11, we celebrate girls, a source of joy, energy and inspiration. Every one of us can point to a girl that has made a remarkable difference in our lives. They are our daughters, grand-daughters, sisters, cousins and friends.

As we commemorate the day of the girl child, we are reminded of the millions of girls caught up in crises all over the world. The theme this year, ‘EmPOWER girls: Before, during and after crises’ is cognisant of the need to ensure that girls are able to survive in a rapidly changing world that grapples with conflict, climate change, violent extremism and forced displacement.

In Uganda, we continue to host over one million refugees from neighbouring countries such as South Sudan and the Democratic Republic of Congo. Women and children are the majority of those affected by this displacement. We are seeing young girls separated from their parents, having limited access to education and having to take care of younger siblings at a time when they can barely take care of themselves.

The United Nations Girls Education Initiative highlights that women and girls are uniquely and disproportionately affected by conflict. Insecurity, displacement and breakdown of social support systems coupled with limited access to financial resources, social capital and legal support leave girls at risk of discrimination and exploitation on many fronts.

Research has shown that girls are almost two and a half times more likely to be out of primary school if they live in conflict-affected countries, and nearly 90 percent more likely to be out of secondary school than their counterparts in countries not affected by conflict. In Northern Uganda, data indicates that violent conflict has had little effect on the education of boys from the wealthiest one-fifth of households. However, the poorest girls from the same area are twice as likely to face risk of extreme education poverty.

We must work together to ensure that girls are protected before, during and after crises. We need to strengthen our engagement with local authorities and communities to ensure that social support systems necessary to ensure that girls are safe and protected continue to function even when communities experience political, economic and social shocks as is common during emergencies. We need to ensure that there are strong policies on protection of women and girls in conflict and that these are implemented effectively.

Through our work in Northern Uganda, responding to the needs of the displaced we have found that protection, education and access to basic services continue to be among the greatest needs for girls in the refugee settlements. We are also helping children recover from emotional and psychological trauma caused by conflict and hunger, which has left them scarred by the past, wondering about today and hoping for a better future.

We continue to work with the government and partners to help children recover and survive. Save the Children is running an Accelerated Learning Programme that follows an approved fast-tracked curriculum to assist conflict and poverty affected children with opportunities to join, re-join and complete their formal education or access relevant vocational skills and livelihood trainings. A good number of girl mothers have enrolled too, and some come to class with their babies. They have a thirst to learn, because they know what education can accomplish for them as individuals, their children and their future.

 

Despite these great efforts, dropout rates among girls remain high, especially in the higher levels, further underpinning the challenges that girls face when attending school.  These include early marriage, household chores, responsibility over siblings, poor menstrual management and for many, the need to sacrifice their own education so that their younger brothers and sisters can go to school. No single girl should have to make this sacrifice – every child, girl or boy, has a right to an education and should enjoy this right.

We need to invest in education systems as a sustainable means to ensure access for all girls and boys and improve its quality. This should include system strengthening, school building, and training and remuneration for teachers. We also need to scale up funding and support for quality complementary and catch-up programmes to provide educational opportunities to children for whom the formal system is inaccessible.

To get all children back into school, particularly girls, we ask the international community to increase funding to help refugee host countries like Uganda provide children with a quality education. Currently refugee education gets only a fraction of the funding it needs. We also call on the Ugandan Government to develop and implement policies that ensure refugee children can attend school and learn from a quality education.

At Save the Children, we are committed to doing whatever it takes to ensure that all children learn, survive and are protected by 2030. We continue to work towards achieving significant breakthroughs in the way the world treats children and girls are no exception. We believe that working together with children and their communities, partners, donors and government can result in real transformation.

Nelson Mandela said that there can be no keener revelation of a society’s soul than the way in which it treats its children. We owe it to our girls to ensure that they have equal access to opportunities, are protected from harm and have hope for the future. Indeed, they are our future.

Brechtje van Lith

Country Director

Save the Children

 

Adjumani General hospital cracks away, earlier report warns the facility is unfit for harbouring human life

By Beatrice Nyangoma

Adjumani General hospital structures have developed cracks causing worry that it may collapse on patients. The cracks started with the Out patients structure in 2012 that was last year rebuilt, according to Michael Ojja, the hospital administrator.

Ojja says that the cracks have developed in the rest of the hospital walls and some of the wards have now been corded off because they may fall any time.

“We are afraid that the hospital walls may fall on to the patients any time. We have now decided that some of the wards be vacated for the safety of the patients.” he said

He however notes that the Ministry of Health and the district leaders have not supported the hospital to get funds such that renovation works can be done despite a warning report on the state of the hospital.

In January 2014 a joint team from the Ministry of Health and the Belgian Technical Cooperation declared parts of Adjumani hospital “unfit for harbouring human beings”.

According to Ojja, by the time the assessment was made three years ago, structures which had cracks on the walls included the out-patient department, the hospital boardroom and maternity ward. He however notes that the cracking has now included the patients’ wards.

A preliminary report showed that the soil texture cannot carry the weight of the structure, and that there was a problem with the design. The team recommended that the affected parts of the structure be demolished before general renovation takes place.

The hospital was constructed for the 232,813 people of Adjumani in 1997. However, according to Ojja the hospital now receives additional population of refugees of 217,000 meaning the facility is recording almost of the population planned for.

Statistics from the hospital show that in the 2015_20016 financial year, Adjumani hospital received at least 67,361 patients at the out-patient department, conducted 1,887 deliveries and admitted 10,937 patients.

Ojja however notes despite the sky rocketing number of patients, the hospital budget has been cut to almost a half. “This hospital was constructed  with a bed capacity of 100 patients but we are operating on a 200 bed capacity meaning that half of the admitted patients actually sleep on the floor. Between 1997 and 2001, we used to receive over 200 million Shillings every financial year but this has reduced to less than 130 million Shillings.” he said

He adds that the hospitals only source of local financing which is the private wing has also been frustrated by local politicians who opposed to charging  patients.

“The local politicians have failed our efforts to complement on the government funding. They stopped us from charging patients in the private wing claiming that this is a public facility and therefore services must remain free of charge.” he added

He says that the hospital received 2 billion shillings from the government that saw the outpatient structure reconstructed adding that the hospital now requires over 10 billion shillings for general reconstruction.

Dr. Sarah Byakika the commissioner for planning at ministry of health on the sidelines of  the African Regional Meeting during the Harmonisation for Patient-Centred Universal Health Coverage meeting in Entebbe, Uganda on the 5th of July 10, 2017 said that the government has not yet got funds for the reconstruction of the hospital.

“The ministry of health is aware of the Adjumani hospital needs but we have not yet got funding. We have however renovated some other hospitals that fall in the category of Adjumani hospital.” she said

Dr. Mugagga Kaggwa, a medical Officer with World Health Organization with specialization in Health Management during the says that the government should focus on strengthening the infrastructure in order to achieve a patient centred health care.

“WHO is now focusing on health care that is patient centered and Uganda cannot achieve this if we undermine the quality of the health facilities that house the patients. The state of the health facilities contributes a lot to the psychological state of patients.” he said

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