Uganda short of 3000 midwives

“I was inspired into midwifery when my cousin sister lost her first child during child delivery, she labored for so long and no one was there to help her. When she got pregnant again, I helped her deliver but got stranded when I had to get rid of the placenta. I had never delivered a mother before, but I was determined to save my cousin’s baby. These were the words of Joyce, a young Karamojong woman now training in Mid-wifery.

My inspiration came from a personal bad experience with a mid-wife, when I gave birth and out of carelessness, my baby dropped down and died. The mid-wife had been extremely rude to me. said Apio another young trainee.

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Barriers to mHealth adoption in Sub-Saharan Africa

In Uganda, and Africa at large, the
populace face many challenges with regard to health including but not limited
to; poor facilities, poor social infrastructure, energy shortage especially
electricity and limited access to education. Despite Government’s effort to improve
on the health system, very few individuals, companies and organizations are
tapping into the potential of mobile Technologies for health, even when the
benefits are obvious to populations whose most accessible tool for communication
is a phone. Below are some of the reasons that I personally think contribute to
the little uptake of mhealth.
Photo Credit: Edward Echwalu
The absence of
readily available mobile health related content on specific thematic areas is a
big barrier. Most organizations that implement mhealth projects have to develop
their own content based on the area of focus. eg HIV, Malaria, maternal health
etc. There is also no central database where this content is put for future
reference or to avoid duplication of already implemented mhealth issues. This
leaves room for data redundancy and duplication to target groups.
2.     Skills
Because of the
tremendous growth in phone penetration especially in sub-Saharan Africa, there
is a great demand for training in mhealth education. One cannot simply rely on
the assumption that because every at least many people own phones, they can
ably use them for mhealth campaigns. They need to be trained on how to operate
the phones, say for health related surveys or how to respond to health quizzes.
This is still lacking. Unless the mhealth campaigns are inform of interactive
Voice Responses (IVRs), the adoption will still remain slow with the use of
interactive SMS messages especially among the elderly populations.

3.     Gender
Although this
is an issue that is often under looked, it plays a key role in either the
success or failure of mhelath project. It’s obvious that the biggest percentage of those who bear
the burden caused by conflict ,disaster are women and children and they are the
key stakeholders in promoting good health and building stable, self-reliant
communities. Also most mhealth related campaigns target mainly women on issues
like maternal health, child mortality, HIV/AIDs, abortions etc. but ownership
of phones is predominantly male who control what kind of information comes
through the phone, whose mobility is not restricted and who are better economically
empowered to afford maintaining the phones especially in rural areas. Therefore,
Making these projects gender sensitive and involving men right from the onset
of the projects will reduce the barriers.
4.     Access/Affordability
This could be viewed in terms of
access to the actual handset especially for the rural folks in rural Africa and
affordability in terms of maintenance such as paying to have the phone charged.
Many people cannot afford a 30USD handset yet most mhealth implementing organizations/companies
only want to work with folks that already own phones. It’s a barrier because
you reach fewer people.

5.     Infrastructure
A lot of mhelath projects in Africa
depend so much on Telecom companies which are responsible for the general
telephony infrastructure eg masts for access to network, distribution of short codes
for those that intend to use SMS etc. In the event that an area does not have
access to a mast, then it is obvious that even if there is a genuine health
need to be addressed through the use of mobile phones, it does not get
attention simply because there are issues of network connectivity. This is one
of the biggest barriers for rural Africa. Also the issuing of short codes by
the Telecoms through communications regulators is bureaucratic.

6.     Attitude
especially in Africa, mobile phones are known for verbal communication. But
with mhealth projects comes a new paradigm shift to the use and application of
phones for accessing health information through SMS. Accepting this change and
adjusting accordingly can be a barrier to SMS based mhealth project. IVR
related mhealth campaigns could be more successful than SMS because voice
messages cut across literacy levels.

7.      Language
This is a barrier because of the fact that the commonly used
language for SMS is English yet sub-Saharan Africa is so diverse. However, this
barrier can be solved through voice messages and using community radios along side the mobile phones.

8.     Political
The success of any project depends on the
positive political will and government support. Often times, mhealth initiatives
by NGOs are meant to compliment already existing government health services and
therefore they must work closely with Government. However, many initiatives
have been destroyed because the Government has not played its role. A case in
point is the moratorium that was issued in Uganda from the Ministry of Health
halting the implementation of all electronic and Mobile Health projects that
were not approved by the Director General. While this was a great initiative to
reduce on duplication of projects and to encourage wider coverage and eliminate
unnecessary pilots, the Ministry did not make the vetting process smooth. It
would take months to have the technical working group at the ministry meet and
approve the projects. This is a source of frustration for projects that have
defined timelines.


It’s BLOG ACTION DAY once again and this year’s theme is FOOD. Sharing my thoughts with you all

late August 2011, I have been travelling from one country to another attending
a number of conference. I just realised that in one way or another, the issue
of FOOD featured so much in all the three conferences.

While some people in some parts of the
world are fighting obesity, others in another part of the world are starving to
death because they have no access to food.
first of these series of conferences I went for was the One Young World summit2011 that took place in Zurich Switzerland from 1st to 4th
September. With a scholarship from MTN, I was amazed at the number of young people
who had convened to talk about issues that are currently affecting the world.
One of them was HEALTH.  The keynote
speaker for the health panel was TED prize winner Jamie Oliver of FoodRevolution
who spoke about global Obesity.
of my tweets during the session on health and food with the hash tag (#fixhealth) were: 

“You and I need to
educate each other about the food that we eat”
“We need to act
against wasting food”
“We need to
respect the fact that we have food and other don`t”
“We all have
passion for food, Yes, but do we have respect for farmers”
“We need to change
our lifestyle and change our eating habits too”
·       “As we fight hunger
and starvation in Africa, we should also sort out the issue of obesity in   the
US and Europe”.
“Food is a basic
need and a human right”
“The general
children are borne in a junk food culture”
“Food Security is
not necessarily about improving production but increasing access to food”.


The Second was the Food, Agriculture and Natural
Resources Policy Analysis Network (FANRPAN) Annual High Level Regional Food
Security Multi-Stakeholder Policy Dialogue 2011 which was held from 19th to
23rd September 2011 in Mbabane (Swaziland). The theme of this year’s
annual regional dialogue was “Advocating
for the active engagement of the youth in the agriculture value chain
 Top on the agenda was the issue of how
youth can be engaged in achieving food security on the African continent. From
the discussions, it was evident that few youth engage in Agriculture and yet
the continent`s largest population is that of the young people.  Her Majesty, Queen Mother Ntombi, Indlovukazi of Swaziland
received the food security policy leadership award for her role in great role
in Agricultural initiatives in Swaziland including one on the Marula fruit
seed. Read more
The question that remained on everyone`s mind was how we can make agriculture `Sexy`
and profitable to the youth.

final conference was the second Global Knowledge share Fair
the world mourned world icons like Nobel prize winner Wangari and  Apple`s Steve Jobs how many thought of the
thousand dying of starvation just 
because they cannot afford a meal?
who thinks that youth have a great role to play for the world and most
especially Africa to achieve food security?

Cervical cancer: A threat to Women’s life expectancy

Cervical cancer is the most common cancer affecting women worldwide and the leading cause of cancer deaths among women in developing countries. According to the Programme for Appropriate Technology in Health (PATH), global statistics show that nearly nearly half a million new cases of invasive cervical cancer are diagnosed each year. And more than a quarter million women die of this disease annually, with the highest incidence and mortality rates being in sub-saharan Africa, Latin America and South Asia. Cervical cancer is the most common female cancer in Uganda. At Mulago hospital alone, 80 percent of women diagnosed or referred with cervical cancer, have the disease in it’s advanced stage.
The causes of cervical cancer have been attributed to early engagement in sexual activities, multiple sexual partners and multiple marriages. Cecil Helman in her book Culture, Health and Illness, identifies that the disease is rare in nuns and common in prostitutes. And while in recent years, there has been a growing understanding of how people’s gender identity determines the nature of their ill health, their vulnerability to disease, their ability to prevent disease and their access to healthcare.  The dimension of feminist theory and females experience puts males’ hostile sexuality at the biopsychological core of men’s subjugation of women. In most situations, a woman’s risk of getting cervical cancer will depend less on her sexual behavior but more on that of her husband or male partner since the disease can be transmitted from woman to another, with men acting as carriers. This mostly applies in communities with cultures that expect men to have many premarital and extra marital affairs as proof of their masculinity, while barring women and looking at them as eminently available and seducible.
Usually women contract the Human Papilloma Virus (HPV) between their late teenage years and their early 30’s. But most often cervical cancer is found much later, usually after age 40, with a peak incidence around 45. There is a long delay between infection and invasive cancer, hence killing many annually often because it goes undiagnosed for many years. And yet the disease is preventable and can be detected and treated at an early stage when the cure rate is virtually 100 percent. Ignorance of the disease of the disease might not be the only threat, but limited access to screening and therapy for precancerous lesions and the low acceptability of pelvic examinations are also contributing factors towards the high prevalence of cervical cancer. Women might also have no control over possible disease transmission if they fail to decide when and where to seek medical attention or when and how they have sex. The imbalance of power between women and men in gender relations curtails women’s sexual autonomy and expands male sexual freedom, thereby increasing women’s vulnerability.
According to PATH, prevention of cervical cancer can be done in two ways; Preventing infection initially or detecting the precursors to cervical cancer and providing treatment. The former can be accomplished by avoiding exposure to the virus through abstinence from sexual activity or through mutual monogamy(when both partners were not previously infected). Condoms only offer 70 percent protection against HPV when used all the time. Vaccination is the other preventive method. PATH is working on incorporating HPV vaccination into a comprehensive cervical cancer prevention programme, through developing a vaccine delivery strategy, a communications strategy for out reach to communities, and an advocacy strategy for outreach to policy makers. Vaccination can be combined with screening. Every woman deserves the right to the highest attainable standard of health, especially the many millions of women who confront illiteracy, poverty, poor sanitation, and medical facilities that are inadequate and physically/ economically inaccessible.