The COVID-19 pandemic has not only brought the whole world to a standstill; it is also a test to Uganda’s multi-sectorial and systematic planning in the face of a major emergency. A case in point is the health sector especially in rural and hard to reach communities. Women are bearing the brunt of the gaps as government tries to balance between full attention to COVID 19 and the risks associated with it, and effective provision of other health services.
On routine monitoring visits to the communities, Merab Alosikin, the Programme Officer of the National Association of Women’s Organizations in Uganda (NAWOU) based in Amudat came across a woman running to the health centre with her baby who was convulsing. The lady was probably half way the journey of fifteen kilometers from her home to the nearest health center. She had tried to contact all the emergency response members indicated to them, in vain. Seeing the crisis, Ms. Alosikin called the Police who came and picked the lady and her baby on a motorcycle and transported to the health center where her baby’s condition was attended to. In three days, the baby was discharged and is recovering well from home. This is but one of the many situations mothers find themselves in under lockdown.
In the three days the baby was hospitalized, Ms. Alosikin visited to encourage the mother as well as other patients. She had an interface with the health workers to establish the effects of lockdown on women due to COVID-19. What stood out is that all critical planning and on-going interventions are precisely targeting the prevention of COVID-19, with limited attention to address other health needs, especially in terms of access to services. With no motorized transport; as even motorcycles commonly known as bodaboda are not permitted to carry passengers, women who live up to a radius of thirty kilometers from the nearest heath centre are failing to attend to ante-natal, peri-natal and post-natal mandatory health visits. These come with a number of repercussions: pregnancy related challenges due to inadequate health attention; child birth at home under the care of traditional birth attendants and its associated risks such as death of mothers and new born babies; and the long term effect of women going back to using local herbs and giving birth outside the care of qualified health workers. A glaring effect of the lockdown is a steep drop in the number of expectant mothers attending ante-natal care at Amudat Health centre, from 78 in February and March, to 28 in April, after the lockdown was enforced. Expectant mothers who still attend ante-natal live within the range of five kilometers or less from the health centre and walk to and fro.
While the President in his address indicated that cases of what seem to be violation of his directives should be treated based on merit, for example, a pregnant woman on a bodaboda should be seen as an emergency, community members do not want to take that risk because of fear. Some of them most likely, did not even listen to the President’s speech and depend on what is discussed in their communities. Many also fear walking out of their homes, even if they could, due to misunderstanding of what is in the guidelines. A considerable number of the population have heard about the guidelines through third parties, each version different from another and full of distortions. A huge number of inhabitants of Amudat do not comprehend English. The media house they have access to is based in Kenya where communication is in Pokot and Kiswahili, the languages they are most conversant in. The district has tried to share messages by deploying the Police and other local government Officers to talk about the disease and how to prevent it and flatten the risk curve, however, due to sparse populations; some communities have not been reached. The district local government and particularly the office of the District Health Officer wish they could pick up expectant mothers, sick babies and children as well as other patients when called upon, however, the district has only one ambulance that is largely dedicated to COVID 19 responses.
NAWOU commends the Government of Uganda for the work towards flattening the curve of corona virus infections in the country. NAWOU however calls on government to re-examine the interventions on issues of health and safety of children, expectant mothers as well as other people who may fall ill and need urgent attention. The situation is even extreme in the case of persons with disabilities and older persons. The experience in Amudat is an example, throwing light on what is happening in the rest of the rural communities. As the lockdown continues, the central government should pay more attention to situations that are falling out of hand during this time, which in the end could cause more deaths than the dreaded coronavirus. On the part of Amudat local government, for immediate mitigation, the health teams have provided telephone numbers that expectant mothers and those with sick children can call for pick up to a health centre. The members of the task force, which NAWOU is part of, have been tasked to share the numbers with communities. This is still inadequate as the district consists of four 4 sub counties, with very poor road network, making it impossible to be served by a sole ambulance. Hopefully, with the support of civil society partners with either vehicles, fuel or both, the district could allocate one vehicle per sub-county for such emergencies. “Partners can provide the vehicles and the district caters for the fuel expenses,” she added. This will save women from walking miles and miles to attend their ante-natal checkups, have safe deliveries as well as access the health facilities for other conditions.