Alice Aganira has been a midwife for fifteen years. Her face lights up as she talks about her work while doing her rounds in the maternity ward at Kagote Health Centre III in Fort Portal, Western Uganda.

“As a midwife the best moments for me are when a mother returns to the health centre with her baby for immunization. Or when I see some of the babies I delivered now grown up and attending secondary school and I know ‘oh I delivered that one’,” she says.

Alice is one of many midwives in Uganda credited for helping to turn round Uganda’s maternal health status. Maternal deaths have reduced from 506 deaths per 100, 000 live births to 336 deaths per 100,000 live births between 2001 and 2016, according to the recently released Demographic and Health Survey.  More women in Uganda — seven out of ten— now deliver with the help of   midwives and other skilled personnel; they are able to receive critical care when it is needed, leading to a decline in maternal deaths.

Fort Portal District where Alice works hosted this year’s national commemoration of International Day of the Midwife on May 5 2017.  The event was organised by the Ministry of Health with support from UNFPA.  The Swedish Ambassador to Uganda His Excellency Per Lindgarde also participated in the event.

The commemoration kicked off with hundreds of midwives marching on the streets of Fort Portal to raise awareness about the work they do.

Committed midwives, poor infrastructure

But beneath the beaming faces of the marching midwives was the reality of the challenges midwives face while providing services.   These include frequent power outages, lack of housing for midwives on night duty and stock outs of supplies such as gloves.

Kagote is no exception. The facility experiences frequent power outages and, because there is no standby generator, the midwives have to use candles to light the maternity ward.

“When we have to deliver mothers at night, we use candles but then you also have to use the torch from the mobile phone so that you can see what you’re doing. You put the phone in your mouth because you are using your hands to examine the mother,” Alice explains.

 According to a study by WHO and the World Bank, lack of electricity remains a neglected barrier to effective provision of health services in y developing countries including Uganda.  A total 58% of health facilities in Uganda have no access to electricity, the study notes.

Looking forward:  More midwives, better working conditions

In his speech at the commemoration, UNFPA Country Representative Alain Sibenaler commended midwives for their role in bringing down the country’s maternal mortality rates.  While noting the efforts made in improving midwifery services, Mr. Sibenaler called for more action to be taken to address the issue of shortages of midwives and to ensure that they receive support to enable them perform their tasks more effectively.

“We appreciate the effort of the government in ensuring that trained midwives are recruited and urge that all efforts are made to ensure additional recruitment especially in hard- to- reach areas,” he said.  “We need to expand midwifery programmes and promote an enabling environment for midwives to effectively serve the needs of women and their families.”

Mr.  Sibenaler noted that with support from the Swedish government UNFPA has supported training of midwives in Uganda as one of the ways to ensure the country has sufficient numbers of trained midwives.  

Since 2009, UNFPA has worked with the ministries of Health and Education to improve midwifery standards in the country by providing support to over 18 midwifery schools, including Virika School of Nursing and Midwifery in Fort Portal.

 A total of 510 midwives have been trained of which 336 (66 percent) have completed training; of those who have qualified, 247 (about 74 percent) have been deployed across the country.

State Minster for Primary health care Joyce Moriku pledged to tackle the various challenges facing midwives in the country. She pledged that the Health Ministry would deal first with the issues of housing to ensure that midwives, who often have to work at night, have accommodation close the health facilities. 

By Martha Songa