Uganda: Advocacy Lights up Maternity Unit

00:17 Jul 15 2013 Nabiswera, Uganda

Sitting in her small office in the maternity ward of Nabiswera Health Centre III in Nakasongola district, Sister Florence Lunkuse clutches a small Nokia mobile phone. She presses a button, and it produces a little glowing light.

“This is the light I have been using to help mothers give birth,” explains Sister Florence, the only midwife at this health centre.
Nabiswera Health Centre III has had no electricity since its inception in the late 1950s. Sister Florence Lunkuse is the only midwife in this health centre, which serves a population of almost 6,000 people. Until last year (2012), though, she used to carry out deliveries of children using the small torch on her mobile telephone. The situation was exacerbated by the fact that the mothers who came to give birth could not afford to buy paraffin to light the only lantern at the health centre.

“I had to help them, with or without light. Because I did not have an assistant, I would put the phone in my mouth, and then use my hands to assist the mother to give birth,” she explains.
The small torch produces just a little light, and Sister Florence says the poor visibility placed both mothers and their babies at high risk.

“This kind of delivery exposed the babies of HIV-positive mothers to infection, since I did not have the necessary visibility for the required caution during a normal delivery of a baby by an HIV-positive mother,” she says. She adds that mothers were also at risk of getting bad tears while in labour, which sometimes would not be stitched well due to the lack of light. Sister Florence says the other risks babies were exposed to were foetal distress, suffocation and swallowing of mucous, all of which compromised their lives.

All this is now history. Last year, the Citizen Voice and Action (CVA) working group in Nabiswera sub-county approached World Vision and requested for solar lighting for the maternity ward. After presenting their case, the request was granted. This has encouraged more women to seek skilled attendance at birth, something most of them had given up on because of the terrifying experience of giving birth in near darkness or being asked to buy paraffin for a lantern when they did not have the money. From three births a month last May, this year the health centre has recorded an average of 15 births per month.

“I am very grateful to World Vision because the solar light has greatly eased my work and made the experience of giving birth more comfortable for mothers. No one wants to go into labour in darkness, let alone give birth with a midwife who can hardly see what she is doing. With the solar, I can now even charge my phone and communicate for an ambulance in case a mother needs emergency help,” explains Sister Florence.
The changes at Nabiswera Health Centre III are attributed to the efforts of the CVA working group. Citizen Voice and Action is a local level advocacy approach to increase local government accountability, which is fronted by World Vision. The approach mobilises and equips citizens to monitor government services, and facilitates an advocacy methodology that results in the improvement of inadequate government-provided services.

World Vision identified and trained the members of the Nabiswera group in CVA, and in turn they sensitise members of the community on the standards required for each service, be it health or education, and their rights as citizens. The group has also sensitised service providers such as health workers about their duties towards the citizens.

Consequently, the health-seeking behavior of the community has greatly improved. From 800 outpatients last year, the health centre receives about 1,000 patients now. According to Jimmy Sengombe, a member of the CVA working group, the staff at the health centre know that they cannot simply miss work or act rudely to the patients.

“The people are now informed, and they demand for quality services. The government and service providers listen because the people’s demands are based on their rights,” Robert Ssali, a member of the CVA working group explains.
Sister Florence’s workload is also about to become lighter. After the CVA working group’s lobbying, the local government has recruited another midwife to work with her.

“The question of sustainability when World Vision moves out of this community is sorted,” says Emmanuel Erayu, the Community Development Facilitator of Nabiswera ADP. “The working group mobilises the community, and the community demands what’s entitled to them. Change is occurring and it will keep occurring.”

“When the community is involved in demanding for these services, they have a sense of ownership over them. They safeguard them and in doing so facilitate sustainability,” says Solomon Ndugga, a member of the CVA working group.
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