Who knew that by simply taking record of the mothers and babies who die, a district could significantly reduce the number of women who die due to child birth related causes? Maternal death audit, as it is referred to in the technical jargon, is an in-depth and systematic review of the numbers of mothers who die during or shortly after giving birth.
By identifying and acting on the lesson learned through maternal death audit, lives of more mothers are saved from dying due to foreseeable causes.
While analysing best practices by the districts at the recent annual review meeting convened by Population Secretariat, Katakwi district was voted the district with best health outcomes among 7th country programme Government of Uganda/ UNFPA partnering districts for 2010. Through maternal audits, Katakwi has, in one year managed to reduce the number of women who die during or shortly after giving birth, from 465 to 370 for every 100,000 live births.
According to the report on best practices, six out of every ten maternal deaths were reported on time in Katakwi district. All the reported maternal deaths were assessed and the resulting recommendations implemented.
One particular example of delays related to accessing ambulance services is instructive. This led to the ambulance driver being housed at the Health Center IV and his telephone be displayed at all public district facilities for easy reach by all deserving beneficiaries. This was implemented and results of improved obstetric emergency response are there to show in the reduced number of women who died during or immediately after birth in the district.
Table 1: identified avoidable factors and recommendations as a result of maternal audits
| Identified Avoidable factors | Recommendations | Implementation status |
|---|---|---|
| 1.Late referral of mothers by Traditional Birth Attendees | Sensitization of Traditional Birth Attendees in the new national policy in Sexual and Reproductive Health and Rights | Done Traditional Birth Attendees told their roles as Village Health Team-members |
| 2.Long distances to nearest Health Center III | Open maternity units at Health Center IIs | Done in 3 Health Centers II's |
| 3. Ambulance often breaks down due to little Primary Health Care funds for maintenance | Allocate resources from District local funds towards maintain of ambulance | Council allocated 10 million from G/Tax compensation |
| 4.Delays in accessing ambulance | Ambulance driver resident at Health Center IV telephone number displayed at all public district places |
Clients call driver directly 24 hours /7 days |
| 5. Mother refers to Soroti due to lack of anesthesia at RHC IV (stock out of anesthesia) | Procure as an emergency anesthesia using local funds | Local funds collected were used to buy anesthesia |
| 6. Communities withhold information during maternal Audit Community follow up | Instruments of local political leaders during follow up | Local Councilors LCIs in involved in community follow up |
| 7. Theatre generator often runs out of fuel | Increase % of Primary Health Care allocations to maternity services | 302 of HCIV recurrent funds allocated to maternity related services |
