Women shun antenatal visits over UShs500

Maternal health. Investigations reveal that a number of mothers in western Uganda are required to pay between Shs500 and Shs1, 000 for every antenatal visit, a thing that has seen many shun the services for traditional birth attendants, who are always willing to help them at no cost.

 

A health worker examines an expectant mother at a health facility in Moroto District. PHOTO BY Steven Ariong. 

Kampala

Only days ago, an expectant mother in Masindi District unexpectedly delivered a baby on the street, leaving dwellers of the small south-western town shocked.

Had it not been for the swift hands of Good Samaritans, Generous Atuhaire’s safety and that of her baby girl, would have been badly compromised.

Although she was taken to hospital shortly, the experience tells a tale of what most expectant mothers go through and the need for regular antenatal visits. According to Florence Adoch, a midwife at Masindi Hospital, such scenarios occur because not many expectant mothers complete their antenatal service visits.

However, in Kibaale and part of Luweero District, where expectant mothers are trying their best to meet the expectations, efforts have been watered down as health facilities demand Shs500 per visit.

As a result, according to the community monitoring group report, most pregnant women, particularly those from rural Kibaale, prefer to deliver under the care of traditional birth attendants, who in most cases are willing to offer free services.

Kisiita Health Centre III in Kibaale has been singled out as the most notorious in enforcing the illegal fees. For example, Rose Tumwebaze says she could not get antenatal services because, according to the health workers, she did not have Shs500 to pay for prenatal services.

It took her nearly a fortnight to return to the health centre with the money, although at the time she thought her condition had already deteriorated. “Many of us were chased away. I think those who didn’t return could have had difficulty getting the money or opted to deliver at home so as to avoid embarrassment and inconveniences,” she says.

Dire situation
Such cases are a drop in the ocean, only representing the predicament a number of women across the country go through daily, with many paying the price with their lives or their babies or even both.

According to last year’s government annual performance report, the number of women delivering in health facilities is alarmingly low, although there is minimal evidence suggesting that there has been improvement from 33 per cent to now 39 per cent.

“There was a modest improvement in maternal care in the last financial year. Although 95 per cent of women who gave birth in the last five years received some form of antenatal care, figures for deliveries in health facilities are much lower,” reads the report in part, attributing this to human resource gaps in most of the health centres across the country.

However, unlike the Good Samaritans who helped Atuhaire deliver safely, it took the intervention of not the government, but a community monitoring initiative called the Village Budget Club (VBC) to bring the issue to light.

“Pregnant women (first timers) complained that at the health centre, they pay for antenatal cards, each at Shs1,000, while for those who had delivered at the facility before, were required to pay Shs500,” Herbert Twikiriza, the secretary of the Kisiita VBC in Kibaale, says. He adds that they had to investigate the claims before they could take action.

“But after talking to some nurses at the health centre, it was evident that the practice was widespread in the western region and deep rooted at Kisiita Health Centre.”

“We conducted a spot check, where we discovered that on that day alone, more than 18 pregnant women were denied antenatal cards because they did not have money.” “We were left with no option but to embark on a move to stop this madness,” Twikiriza says.

With the help of Forum for Women in Democracy (Fowode), three Village Budget Clubs were created in Kisiita Sub-county to confront this and other community ills that should have ordinarily been sorted by either local or district authorities. As a result, the VBC compelled the health centre to refund the money they collected.

When the Saturday Monitor visited the health centre, the in-charge was not around, but according to a clinical officer, William Komagwa, who said he was standing in for the in-charge, the habit of selling antenatal cards had since ceased. Meanwhile, in Luweero, health workers have made it a habit to steal government drugs and money meant to run health units.

According to the Kyegombwa VBC, most of last year, Kyevunze Health Unit did not have drugs, yet the government gives it about Shs7.2 million annually to stock its shelves.

In the same period, the VBCs monitored Kyevunze Health Unit and found out that the unit had a few or no drugs at all most of the time. Worse still, it was hard to differentiate between patients and the health workers as the nurses were not wearing uniforms. Also, community members of Kasaana Sub-county complained that they have not been receiving drugs in the past two years yet accountability for that money had already been made.

Funds mismanagement
It was further found out that, the Shs7.2 million that the government provides to the health units is being managed in a personal account of a health official.

Although all the maternity mess is yet to be sorted out, the efforts of the VBCs has helped restore some level of sanity in several health centres. According to the Luweero gender officer Edith Nakigudde, intimidation could be just one of the various forms local and district officials use to avoid scrutiny by the VBCs. However, their resilience is enough to see them continue the fight against maternal mortality in the country.

List of mothers who were refunded

Names Village Sub-county Refunded
Emily Tumwebaze                Bwikaragye Kisiita Shs1,000
Loy Kakuru                        Kyangota Kisiita Shs1,000
Margaret Tuhaise                Masaka Kisiita Shs1,000
Mercy Birungi                     Kangota Kisiita Shs1,000
Voilat Abitekanizae             Bwikaragye Kisiita Shs1,000
Flavi Kobusingyea               Kisiita Kisiita Shs1,000
Brenda Kobusungye            Kyapera Kisiita Shs1,000
Shallon Koburungi               Nyaburungi Kissita Shs1,000
S Nakate Bwikaragye          Kisiita Shs1,000
Kyarikunda Bwikaragye        Kisiita Shs1,000
Aha Niwe Kyakajoro            Kisiita Shs1,000
Stedia Ninsiima Bwikaragye  Kisiita Shs1,000

Tumukugize Bwikaragye       Kisiita Shs1,000

Owabigabirwe Buhumuriro    Kisiita Shs1,000

E Kamusiime                     Kisiita Kisiita Shs1,000
 

TOTAL Shs15,000

Source: Daily Monitor