Like many African countries, Uganda is still far back in the Health care provision compared
to the developed walled. The situation is worse as you go further into the Ugandan villages. Many interventions have been put in place by the government to improve
the health care provision but there is still a long way to go.
One of the indicators of health is the infant mortality rate (IMR) and under five mortality rate (UFMR).
In Uganda they are at 76 and 137 per 10,000 live births respectively. This means that one in every 13 babies born in Uganda does not live to their first birthday,
and one in every seven Ugandan babies does not survive to the fifth birthday.
(From the Uganda health and demographic survey 2006)
ATOS a Non governmental organization and a CBO currently working in Nabbaale Sub- county is ready through its health programs to help in intervene and improve the health
in Ugandan villages, because not only the children are affected but also the adults. And more so the health of the children depends much more on that of their parents.
Programs involved to counter health problems include;
- Making clinical diagnoses with in the community with appropriate referral to the specialized centers for better management
- Prevention and management of reproductive tract infections.
- Maternal and child health.
- Family planning services.
- Training of tradition birth attendants.
- Sensitization to reduce violence against women/girls.
MATERNAL AND CHILD HEALTH.
According to the research done by the organization, there is importance on achieving the policy goals of reducing Maternal,
infant, and child mortality and morbidity.
Several programs have been introduced to reduce the maternal mortality ratio (MMR) which is defined as the number of maternal deaths during pregnancy, child birth and
puerperal period (42 days following delivery) and not due to incidental causes.
This is at 345-524 per 100000 (from Uganda health and demographic survey 2006).
Maternal deaths represent 13% of all deaths in Uganda. This situation is due to poor reach of health care delivery network in rural areas.
Infant Mortality Ratio (IMR) refers to the possibility of an infant surviving up one year.
Studies show that infant mortality rate is higher in rural areas than in urban areas .IMR declines sharply with increasing education and awareness of the mothers.
Gender inequalities hamper access to health services. Even when services are available, the utilization of services can be inadequate. This is due to ignorance or
prevalent socio cultural practices reinforced by the low status of women; early marriage, child bearing and early motherhood increase the risk of maternal morbidity
and mortality and infant mortality.
Maternal and child health is also severely affected by repeated pregnancies. We have realized that the girl child’s health is more
neglected in the villages often due to socio culture reasons such as son preference.
The organization has identified the key strategic intervention areas;
Access to Quality Ante Natal Care Program.
- Increasing knowledge on danger signs during pregnancy and delivery early prediction of complications, weight monitoring, completion of immunization, appropriate nutrition
and nutrition supplements.
- Development of a birthing plan and ensuring availability of skilled birth attendants at the lower health levels
Institutional Deliveries through skilled attendants at delivery.
- Appoint qualified nurses to conduct normal deliveries with back up transport for referral in the event of complications.
- Mobilize community support for transport for referral in case of complications.
Essential Neonatal Care:
- Communication and education on components of essential neonatal care.
- Provision of Essential neonatal care in home deliveries.
Access to Quality Child Survival Interventions.
- Establishing depot holders for ORS and cotrimoxazole tablets.
- Scheduling immunization programs once a month in each village.
- Counseling of parents for improved care seeking behavior.
- Nutrition Rehabilitation Center for the children with protein energy malnutrition.
Coverage:
The organization is accepted to cover 30-40 villages allover the district of Mukono and
later other parts of the country.The organization will provide basic packages of MCH programs in these areas.
It will also establish linkage with referral programs, especially with basic and comprehensive emergency obstetric care facilities,
either in public or in private escort.
FAMILY PLANNING PROGRAM;
Family Planning Program is part of the programs conducted by the organization.
The survey done by the organization on this program and with the help of the National family health survey, this is an important
component, which shows awareness regarding general family planning (Male and Female sterilization) in the community. However,
knowledge regarding spacing methods is inadequate and limited. More over, the increased awareness has not been matched by increased
access to family planning products and programs.
The organization estimated unmet needs for contraception at around 30%. It indicates
that the unmet demand for both limiting and spacing continues to remain high in many areas.
In rural areas, dependable sources of contraceptives
supplies (oral pills, condoms) and follow up care for acceptors are not easily available. Alternative programs delivery systems such as commercial,
social marketing and community based distribution systems are yet to take roots in rural areas.
The organization has identified the key strategic intervention in the areas of Mukono district in Nabbaale Sub-County.
Demand Generation in the community for Programs through awareness, information and products. Method includes.
a) Orientation programs for various stakeholders such as eligible couples, young male and female, teachers, community leaders on composite family planning products and services.
b) Designing communication plan/activities for men, women, adolescent girls and boys for addressing biases/barriers relating to family planning.
c) Health education / training for women groups.
d) Mobilizing eligible couples, individual’s men and women, to participate in family planning .
e) Training of providers of organizations for all methods on skills and for providing gender sensitive programs
f) Family Planning programs for eligible couples and your adults including counseling, natural temporary and permanent methods, and referral. Methods include;
a. Establishing clinic days for offering contraceptives.
b. Providing an expanded range of quality contraceptives.
c. Clinical and gender training of services providers of organization for all methods
- Community Based Distribution of Contraceptives.
a. Establishment of depot holders in each village for easy availability of family planning programs.
b. Training of depot holders / Volunteers in non-clinical spacing contraceptives, gender and counseling skills.
c. Initiative to promote encages of women groups with the health system.
REPRODUCTIVE TRACT INFECTIONS (RTI) AND SEXUAL TRANSMITTED INFECTION (STI)
Reproductive Tract Infections; (RTI) including sexually transmitted infections (STI) are being recognized as a problem.
This has been brought into the reproductive health agenda. Many RTI s
are sexually transmitted.The emergency of HIV and identification of STIs as a facilitating factor for transmission of HIV/AIDS has led to efforts of designing appropriate
programs to address unmet needs for RTI/STI.
According to survey done by the organization in 20 villages in Mukono district in Nabbaale Sub county, it was discovered that young people in this villages stand a greater
risk of contracting sexually transmitted diseases including
HIV/AIDS, due to early on set sexual activities, reluctance /ignorance to use preventives methods and frequency of partner change.
The common causes of RTI among
women in the rural areas include infections due to inadequate medical procedures such as unsafe abortions, unclean deliveries and other diagnostics and therapeutic
procedures; infections associated with inadequate personal sexual and menstrual hygiene practices and sexually transmitted infections. Through this both men and women
get infected, the prevalence and the consequences are much more severe for women.
Women in rural areas hesitate to discus the issue of RTI since it is related to sexual
activities untreated RTI /STI create complications resulting from spread of infection to other part of reproductive tract or other organs of the body major complications
include infertility, entopic pregnancy and cervical cancer resulting in mortality or psychological problems for women. Some infections may cause fetal wastage pre term delivery.
Treatment of women for STD and RTI S without the cooperation of men is an area of concern in the management of RTIs. Self-reporting of gynecological problems is low.This is because
it is associated with a sense of embarrassment and shame. This affects chance of being diagnosed and treated; extra marital sex of male partners contributes to the problem.
Lack of
negotiating ability of women in the practice of unsafe sex by partners also contributes to the problem. Treatment options available to the women are limited by a number of factors.
These unclouded asymptomatic natures of these diseases in women, their access to programs, non availability of female doctors, cultural resistance to gynecological examinations, and
lack of availability of non stigmatizing treatment in public sector.
Patients find it easier to use the services offered by unqualified quacks.
There is need to increase the availability of qualified personnel to meet the unmet needs for the management of RTI.
The organization identified the following areas of strategic interventions:
- Behavior change communication and social mobilization
a. Planning local area level communication strategy for BCC, with a focus on community members, especially women to protect themselves from RTI/STI and HIV infection.
b. Implementation of the communication plan for emphasizing preventive behavior.
c. Orientation programs for both private and public sector providers for sensitization to gender issues and issues of partner management, compliance, condom use and counseling for avoiding risky behavior
d. Outreach program for community based groups
- Promoting Dual Protection.
a. Depot holders providing quality condoms for dual protection in all villages
b. Communication of activities by depot holders for prevention of STIs in all villages
- Management of Symptomatic Individuals:
a. Setting up mobile clinics, attached with small lab set up for the purpose of enhancing sensitivity of synchronic approach for
the vaginal discharge patients. Simple lab tests like; gram staining, PH test and wet mount can be offered through these clinics, such clinics need to be designed in such a manner that the same villages are visited again after seven days for the follow up.
b. Provision of lab equipments and reagents, drugs and medicines.
- Organize orientation programs for raising awareness on causation transmission and prevention of RTI /STI including HIV/AIDS early diagnosis and immediate treatment of RTIs.
Voluntary doctor sensitizing both adults and
the youth on different diseases. |
Some of the diseases that affect people in rural areas. |
The Current Situation and Challenges:
Some of these programs have already started though others are yet to start, but our dream is
to have all the
programs running such that there is marked improvement in health in Ugandan
villages. We need your support to these challenges including;
- Effective facilitation of doctors and nurses who come to Clark, examine and treat/refer the patients. So far they are coming in once a week due to minimal funds, but we would like this to be at least five days a week.
- We don’t have enough of the basic drugs for the treatment of the common conditions.
- We lack teaching aids.
- We have limited equipment used in clinical examination and our aim is to be able to diagnose most of the different kinds of diseases and their complications such that were possible timely and appropriate referral is made.
- Also we don’t have an established structure from where to carry out theses services. They are currently being carried out from in one of church member’s residential house. In plan, the structure is to be at Ndese SDA Church.
- In future we expect to have a very big hospital in place (at Ndese) and land for this is also already available.
CONCLUSIONS;
There is need for support in terms of;
- voluntary health workers
- Materials which may be used in basic heath care, such that these services may go on effectively.
- And also any other forms of support that you can accord us are very welcome.
