Less than half of Katine women give birth in health centre

Efforts to ensure that all women in Katine sub-county give birth at a health centre still have a way to go after statistics indicate that the majority of women are still delivering at home. Figures show that between 40 and 45 women give birth at Tiriri health centre each month. According to the African Medical and Research Foundation (Amref), the NGO implementing a development project in Katine, funded by Guardian readers and Barclays, the estimated number of women giving birth in the sub-county each month is 118. Figures were collected from Tiriri health centre and from reports delivered to Amref from the village health teams (VHTs), whose role is key in reducing the disease burden in the sub-county. On average 73 (about 60%) of pregnant women in Katine either deliver at home, in other health units or other unknown places. It is suspected that women who did not give birth at Tiriri, which is considered to be a mini hospital serving residents from seven sub-counties, would have done so at home. A trained health worker would need to be employed at a centre for women to be allowed to deliver. Katine suffers from an acute shortage of trained health workers. Women could give birth at the district hospital, but that is located more than 20km away, which makes the transport costs prohibitive for the majority of the Katine community. The 60% figure chimes with district-wide figures. A report last year found that around 43% of women gave birth in health centres in Soroti, the district in which Katine is found, up from 26% in 2000. There is no clear answer to explain the trend even after Amref and other development partners have put a lot of resources into encouraging women not to give birth at home in poor and unhygienic conditions. Women who give birth at home often rely on traditional health attendants (TBAs) to assist them. In Katine, the TBAs have received training from Amref to encourage safer deliveries. Part of the training has included when women need to be referred to a health centre. Around 70% of women in Uganda access antenatal care. The figure drops to around 50% in Katine. According to the Reproductive Health Journal , the use of health services is related to availability, quality and cost of services, as well as the social structures, health beliefs and personal characteristics of the users. Citing the World Health Organisation (WHO), the journal says more than half a million women die each year from complications of pregnancy or childbirth. In Uganda, 6,000 women die each year. The presence of trained medical staff could greatly reduce this number. In Soroti, maternal mortality rates have significantly dropped over the past 10 years, from 750 to 190 deaths per 100,000 live births, largely because of a WHO programme to ensure more women had access to better healthcare. Since Amref began its work in the sub-county the number of deaths in Katine have also dropped. During the first year of the project, there were no recorded mother or child deaths, compared with three deaths during childbirth the previous year. However, there are fears that the work could be undermined as Amref has stopped offering training to the TBAs, who have been instrumental in referring mothers to deliver at health centres, and supplying reports to the NGO. Amref's health officer in Katine, Joseph Otim, says the NGO stopped working with TBAs at the end of last year following a communication from the Ministry of Health terminating the services of TBAs. No support for traditional health attendants Last year, the health ministry announced the end to the recruitment and training of TBAs after finding out that they had deviated from their major role of identifying and referring pregnant mothers to health centres, said Rose Mary Anaso, the Soroti's assistant district health officer in charge of maternal, child and nursing. In a circular terminating support for TBAs, the general director of health services at the ministry, Sam Zaramba, said: "The Ministry of Health recognises that there is a big unmet need for skilled attendance especially in hard to reach areas, a fact that often drives women to seek services from TBAs. However, by training them, we send mixed messages and this may be mistaken for endorsement of TBAs as a strategy to reduce maternal mortality." Zaramba said TBAs can only now work as VHTs ─ that is if the community members elect them. The government has recognised there is a shortage of qualified health workers, particularly in rural areas, but does not appear to have addressed the problem. Last week, at festivities to mark International Women's Day, the Ugandan president, Yoweri Museveni, said he was aware of the problem of maternal mortality but had not studied it properly. He blamed corrupt doctors and hospital structures and cultural sensitivities for the problem of high rates. Some of the roles VHTs would now take over from TBAs are registering pregnant mothers, detecting danger signs among pregnant mothers and babies and encouraging mothers to go for antenatal care, delivery and post natal services at the health facilities. According to Teddy Akello, an in charge antenatal nurse at Tiriri health centre, the withdrawal of support for TBAs is affecting deliveries at the facility because very few mothers come to deliver at the health centre. "They used to bring monthly reports, now they don't," she said. Akello added that outreach programmes arranged by Tiriri to help health workers educate community members on safe motherhood have had to stop because of lack of funds. Amref had supported the programmes, contributing to transport costs, but withdrew this support to allow the health centre to take charge of the work it does before Amref leaves. Otim said every health centre is expected to conduct outreaches with the support of primary healthcare funds. In an attempt to explain the low number of deliveries at the health centre, residents who talked to the Guardian said that health workers are usually slow to attend to them, especially when a woman goes into labour at night.