On 5th
March 2012, I joined a team of medical doctors and environmental specialists
from UNICEF Kampala for a trip to western Uganda. This was a mid-term review on
the progress made in health services provided for a two year project in the
areas of Prevention of mother-to-child transmission (PMTCT), HIV/AIDS and
Malaria. We visited three districts of Bundibugyo, Kabarole and Kyegeggwa. UNICEF-Kampala
in partnership with Ministry of health and other partners like Text to Change
and Catholic Relief Services (CRS), is working tirelessly to achieve the 4th,
5thand 6th millennium development goals (MDGs) of:
Goal 4:
Reduce Child Mortality,
Goal 5:
Improve Maternal Health
Goal 6:
Combating HIV/AIDS, malaria and other
major objective of this initiative is to increase public demand for Antenatal
care (ANC) and Post Natal care (PNC) services at health facilities among
mothers in rural Uganda.
It is
evident that in emergency, the biggest percentage of those who bear the burden
caused by war, conflict and disaster are women and children, yet they are the
key stakeholders in promoting good health and building stable and self-reliant
communities.  With only 2 years left to
2015, a year set by United Nations to achieve all the 8 MDGs, many organizations
are working tirelessly to meet this deadline. During our 3 day visits, we went
to a number of health centres which included; Burondo HCII, Ntandi HCII both in
Bundibugyo as well as Kigambo HCII in Kyegegwa.
Why Maternal health in Uganda?
to the 2010 Millennium Development Goals progress report for Uganda, maternal
health indicators for Uganda have generally remained poor in the last two
decades. Over the period of 1995-2000 maternal mortality stagnated about 505
deaths per 100,000 live births. The Uganda demographic and health survey of
2006 estimated Maternal Mortality Ratio (MMR) at 435 deaths per 100,000 live
births, making a total reduction of only 70 deaths per 100,000 live births in
half a decade. The 2007 ministry of health expenditure survey in Uganda clearly
indicates that the main causes of maternal morbidity and mortality in Uganda
have overtime been considered preventable and or treatable. These common causes
include but are not limited to abortion, haemorrhage, sepsis and obstructed
labour. When we visited Ntandi Health Centre III in Bundibugyo, we were
welcomed by this message;
Needs more health centres; Bundibugugyo needs more well quipped maternity
A banner hanging at Ntandi Health Centre III in Bundibugyo

statement that was confirmed by the Chief Administrative Officer Mr. Okuraja David of
Bundibugyo when we later on visited and talked to the district leaders.

Ntandi, We met the only enrolled mid-wife Ms. Grace Agaba who was busy helping
carry out in an immunization exercise. When we spoke to her, the visibly tired
Grace emphasized the problem of the health centre being under staffed and sometimes
having drug stock outs. She also complained about the absence of
light/electricity at the centre that makes it complicated to help mothers who
deliver in the wee hours.

“This morning at about 5:00 am, I carried
out a natural delivery using the torch light of my mobile phone
said Grace
also cited the absence of registers for patient details at the centre, she said
that because of this, mothers are requested to carry exercise books to have
their details written, which she says is not a good option as many loose these
books hence making it difficult to track their health history. When asked by
Dr. Richard Oketch (HIV/AIDS specialist Treatment at UNICEF) about HIV Positive
mothers, Grace said that they test all mothers for HIV/AIDS during their first
visit to the centre and if found positive, they start administering the Antiretroviral
drugs (ARVs) 14 weeks during the Gestation period. They give them zidovudine (AZT) drug used to delay development of AIDS (acquired
immunodeficiency syndrome) in patients infected with HIV until
delivery and then Combivir which is used to treat HIV. For the new born babies
Niverapine syrup is administered within 72 hours of birth, she said.

expressed a lot of concern for the pigmy community made up of the Bawta in bundibugyo
district. She said that the biggest dilemma is that approximately 60-65% of the
Batwa are HIV positive yet they are very aggressive and difficult to reach out
to with better health services that prevent transmission. She was hopeful that
if they are mobilized through their King, the process will be easy. UNICEF
recommended specific outreach to this group of people through Village Health
Teams (VHTs) from their community.

Hope in Technology through Text to Change.
Will it help?

To realise the indicator of having mothers
come for all the 4 ANC visits, we need to have something that reminds these
”-Sr. Nyinakamunya Generose

such a statement, it is evident that although the mothers go to the Health
centre for Antenatal (ANC) and postnatal (PNC) services, they need to often be
reminded if they are to go for at least the required four visits during pregnancy.
It’s for this very reason that Netherlands National Committee for UNICEF in
partnership with UNICEF-Kampala and the Ministry of Health sought for a partnership
with Text to Change a mobile4dev organisation that improves access to
information in a cost effective way to reach out to several of these mothers through
the Simple Message Service (SMS). For my part, I was tasked with testing the
language and comprehension of some of the messages that have been develop and
this was for one reason; to make sure that they in the simplest language that
can be understood by an ordinary mother but still remain medically correct. I
had to test for the clear understanding and seek alternative options for
medical terms like Convulsion, postnatal, Transmission, premature, ITN voucher,
caesarean section etc.

Maureen Agena texting the language and Comprehension of the SMS messages at Ntandi HC III
short messages, Text to Change intends to reach out to hundreds of mothers by
sending out two 2 to 3 messages weekly on topical issues like malaria,
Nutrition, HIV/AIDS, ANC and Postnatal. It will be backed up with radio programs for a bigger
outreach and greater impact to the communities.
Similar blog of maternal health
by Uganda Journalist Rosebell Kagumiire: