Jamra primary scholl for children affected by HIV/AIDS, drugs or poverty, Senegal (c) Nell Freeman/Alliance Participants in the Photovioce project, Ecuador © Marcela Nievas for the Alliance
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Pulling together to prevent HIV and improve maternal and child health


Juliet Aheebwa, midwife at the Bombo health centre. (c) the Alliance

Uganda has one of the highest maternal and child mortalities in the world. Every day 16 women die giving birth and each year more than 30,000 babies are born with HIV.

With around 38 per cent of the country’s population living below the poverty line, this beautiful country faces many problems but it’s the issue of maternal and child mortality that is one of the most severe.

Thanks to a UK aid project, implemented by Alliance Uganda, civil society and community organisations have united across Uganda determined to improve maternal and child healthcare in an attempt to reduce the appalling levels of child and maternal deaths in this impoverished nation.

The funding from UK aid has supported 26 civil society and community based organisations, to work together on improving maternal and newborn child health in Uganda and to ensure that HIV positive women are receiving the care they need to prevent passing HIV on to their newborns.

Working together

“The range of organisations working together is amazing,” says Gerald Kato, policy adviser,  at Alliance Uganda. “We have religious leaders, women living with HIV, managers of health facilities, traditional and cultural leaders, traditional birth attendants and members of Health Unit Management Committees all pulling together to make a difference in maternal and child health.

“One of the project’s aims is to strengthen the levels of community referrals to maternal health services and increase the numbers of women using these services. Many women don’t know what health facilities are available to them so we started by mapping the available maternal and newborn health service packages,” says Gerald.

This included: PMTCT, family planning, antenatal care, STI/STD testing and management, ART, VCT, child immunisation and hospital delivery services by location.

“Each partner then sent 2 peer educators to be trained in maternal, child health and HIV/AIDS integration. They then returned to their community to train others and reach out to the grassroots population to inform women of the services available to them - when the health facilities are open, what they provide and how they can be helped,” Gerald explains.

Fighting fears, changing attitudes

It’s no easy task. Fear plays a huge role in preventing many women from going to health clinics. Women complain that the health workers are rude to them, they have long distances to travel to get to a health centre, they can’t afford to pay for the treatment and when they do go they’re not sure what to expect. They would rather put themselves in the hands of local but unskilled Traditional Birth Attendants (TBAs), even though they are banned from operating by the government.

Despite the odds, peer educators are slowly turning attitudes around. An impressive 500 peer educators have been trained, 40,781 women have been provided with information and 37,958 referred to maternal health services from September 2010 to August 2011.

“Since the start of this project, existing reports indicate that health facilities that were seeing 5 mothers a week for delivery are now seeing more than 20,” says Gerald.

“Awareness on maternal health issues is very high now and the health providers are more accountable, sensitive and responsive because of higher visibility and profile of the issues. For the first time in the history of this country the ordinary Ugandan is getting interested and concerned in the quality of health services and so healthcare providers are becoming more accountable - the health facilities are listening.”

Juliet Aheebwa, midwife at the Bombo health centre with NSAs, working together on the MNCH project (c) the Alliance

Linking communities and health services

In Luwero district in Uganda, Nyimbwa Multipurpose Organisation of People Living with HIV/AIDS is involved with local communities to increase the numbers of women attending the local health clinics. In just one quarter 121 clients were referred by Network Support Agents (NSAs) to health centres and offered HIV pre and post testing, counselling, ARV support, PMTCT and condoms. Network Support Agents (NSAs) are people living with HIV and members of the local community who were trained and supported by the Alliance to support people in their community in HIV testing, reducing stigma and providing care and support, as well as referring people to local health services.

They are making a significant difference in educating and encouraging women to attend the local health centre as midwife Juliet Aheebwa from Bombo health clinic in Luwero district explains:

“The patients feel good when they see NSAs while they are at the clinic. They feel free to air their concerns. Our workload reduces because they give health education talks and work with people to help them take their medication. The number of women we deliver now has increased from 10 to 35 in a day. We encourage them to keep doing their work. There are certain things that clients don’t tell us but will share with the NSAs so they can give us feedback and that helps us.”