Safe Motherhood: We cannot achieve development without addressing maternal mortality

Sarah Brown, safe motherhood advocate and wife of former Prime Minister of the UK Gordon Brown once said, “I don’t believe that we will make the progress on HIV/Aids without addressing maternal mortality. We will not make the progress we want on malaria without addressing maternal mortality. We will not make progress on getting more children to school without reducing maternal mortality. When a mother survives, a lot survives with her.”

We have heard and read a lot about causes and statistics of pregnancy and childbirth and it is time we step up our act to save the mothers of this nation. Whereas the ways of ensuring safe motherhood are of the much part straightforward, their implementation can be complex.

But first, allow me send my sincere condolences to the family of the late Cecilia Nambozo from Mbale District who would probably be with us today had she received the necessary attention on time. Her tragedy depicts the plight of many other mothers out there in labour wards. Nicholas D. Kristof, a New York Times journalist, once noted that “Half a million women die each year around the world in pregnancy. It’s not biology that kills them as much as neglect.” Well said, I bet. There are those health workers who uphold the good image of the profession by acting professionally and these should be acknowledged but those who abuse the profession by neglect of duty in any form must be held accountable.

In fact, there is undisputed evidence that improved performance doesn’t necessary have to cost a lot. Developing countries such as Egypt, Tunisia, China, Malaysia, etc have embraced good practices which have remarkably reversed the rate of maternal mortality and morbidity. They have put their existing resources to better use by exploring cost-effective options to enhance the capacity of national health demands, systematically strengthened the healthcare systems, and drummed up grassroots support for the cause. I, however, acknowledge that the facilities and incentives of healthcare workers need to be improved.

Maternal death hugely compromises all the key human rights you can imagine such as right to life, family, education, health, etc. Human rights violations such as female genital mutilation/cutting, forced early marriages, gender-based violence, violation of women’s economic and property ownership rights, etc, constitute a major violation of a woman’s right to make decisions regarding her life and body leaving her vulnerable to social evils. It is obvious that the poorer the household, the higher the risk of maternal death.

According to the UNFPA fact sheet; worldwide, there is an estimate of 210 million pregnancies, 80 million unwanted pregnancies, 50 million induced abortions, 20 million unsafe abortions, 68,000 deaths from unsafe abortion, and 20 million infections and disabilities following childbirth. We need to make sure that Uganda is not affected by such statistics by avoiding unwanted pregnancies and encouraging family planning.

Within the context of inadequate financial resources, mounting health demands, escalating healthcare costs, rising population, and heightened public expectations, midwifery and nursing services present a platform from which we can scale-up health interventions to assist in meeting national health targets. We need to strengthen and make affordable midwifery and nursing education while efficiently managing maternal and neonatal health challenges. Without adequate fully qualified midwives at their work stations, almost all the other strategies to reduce maternal mortality and morbidity are bound to fail. Among other key interventions, we need to invest in midwives and increase availability of emergency obstetric care, address unwanted pregnancies, encourage delayed first birth for adolescents, promote cross-sectoral linkages, reduce the risk of unsafe abortion, stamp out Female Genital Mutilation and address contextual factors such as women’s education, lack of male involvement, access to economic resources, etc.

Most importantly, all workshops discussing strategies must ensure that they have the active presence of policy makers to cultivate ownership on their part. Otherwise, the great ideas will always remain on paper.

Mr Masake works with Uganda Law Society. 
mskmas@yahoo.co.uk

FAMINE AND ENVIRONMENTAL PROBLEMS ARE CHILDREN OF THE SAME MOTHER

The Horn of Africa is currently facing acute food shortage, severe malnutrition, famine and over 11.6 million people are being directly affected. Scores of people and animals have reportedly starved to death and millions are surviving on a single meal a day. Scenes of rotting animal skeletons and sunken eyes of malnourished bony children on national television are commonplace. In the face of these difficult economic times, it is only obvious that the crisis is bound to worsen unless a lot is done to mitigate the situation.

In Uganda, districts of Moroto, Napak, Kotido, Amudat, Kaabong, Nakapiripirit, Abim, Amuria, Katakwi, Adjumani, Arua, Koboko, Moyo, Yumbe and Bulambuli have already been tagged a red-zone area by the government. It is however wise to anticipate that the humanitarian crisis may stretch across more districts in the face of sky rocketing food prices amidst declining purchasing power and low harvests. 

In as much as several factors are responsible for this huge humanitarian crisis, poverty, starvation/famine and environmental problems are children of the same mother, and that mother is ignorance. Ignorance of the relationship between nature and human well-being.

The challenge of seeking to avoid future starvation and famines in the region is daunting but one we immediately must all work towards since drought is a recurrent phenomenon and we have to live with it. The UN Secretary-General Ban Ki-moon noted that “short-term relief must be linked to building long-term sustainability …….this means an agricultural transformation that improves the resilience of rural livelihoods and minimizes the scale of any future crisis. It means climate-smart crop production, livestock rearing, fish farming and forest maintenance practices that enable all people to have year-round access to the nutrition they need."

There is no way agricultural transformation which improves rural livelihoods can be attained when man is hostile to biodiversity. The Millennium Ecosystem Assessment presents a credible argument that human well-being largely depends on the services provided by nature. 

Biodiversity is declining rapidly due to drivers of which most of them are human-induced such as climate change, land use change, economic activity, technology, human population, habitat loss, pollution, overexploitation and other socio-political and cultural drivers. These drivers tend to interact and amplify each other.  

Biodiversity loss posses strong negative effects on several aspects of human well being such as food insecurity, and sudden environmental changes such as droughts, acute deterioration of farm soils fertility, floods, diseases and scarcer access to water resources.

With the explosive human population in this region of the world, communities have various competing goals, many of which depend on biodiversity. Due to socio-economic pressures, people are increasingly putting more pressure on ecosystems by trying to modify them to improve on their productivity which results in an irreversible change of the ecosystems. In the long-term, the value lost of such trade-offs may by far exceed the short-term economic benefits that may have been gained from the trade-off as we are now experiencing.

To mitigate this calamity, the necessity to tag monetary value benefits to an ecosystem by assessing their full economic value is crucial. 

It is wise for us to conserve our biodiversity by integrating it into agriculture, forestry, and fishery sectors because they affect it directly since they are wholly dependent on biodiversity. We need strong institutions in place to enforce sustainable use of ecosystems and inform communities of the benefits of conserving biodiversity. Other actions such as adapting to climate change and increasing transparency of decision making processes need to be put in place as well.

Masake Anthony

The writer works with Uganda Law Society

mskmas@yahoo.co.uk

WETLANDS: THE TALE OF TWO CONSTITUTIONAL RIGHTS

While the country was busy with the swearing-in ceremony of the president and the return of Besigye, we had to stare in horror and utter shock while over 2,500 people descended on Lubigi wetland like woodpeckers on a tight deadline with utmost impunity in broad day light armed with poles to erect a market. As if all of a sudden, all the land was declared vacant and people were supposed to serve themselves on a first come basis. Not even the line honorable minister was able to spare us such irritating scenes. My prayers rest with Lubigi and other wetlands out there across the country.

But first let us look at the some of the driving factors. Setting up a market for economic purposes was at the fore front. Whereas the constitution guarantees the right to engage in economic activities, it also guarantees a clean and healthy environment for all Ugandans. As to which one of these was more important in the Lubigi saga is obvious and not a subject of debate. 

“If government is setting up a sewage plant, why can’t we set up a market?”, “We know this is illegal but we also want to work and earn a living” These were some of the arguments being advanced by Lubigi wetland encroachers when asked to vacate the water catchment area as quoted in the Daily Monitor. This is awfully worrying and everything should be done to change this type of myopic thinking lest such impunity as witnessed at Lubigi soon spreads across the country and honestly, I do not see our institutions handling this one effectively.   

The government of Uganda is mandated to protect the natural resources including wetlands on behalf of Ugandans and by doing this, guarantee a healthy and clean environment for her citizens. The environmental benefits of wetlands are by far more important and priceless to be compared with the economic benefits.

The state minister for Environment Jessico Eriyo stated that the ministry had acquired GPS machines for boundary demarcation of wetlands to overcome the problem of people claiming titles in the wetlands. Whereas this is important, a lot more is desired if these resources are to be protected. People can still encroach on wetlands without acquiring titles as to ownership and that is bad enough. 

On 28^th of January 2011, in my article titled “The effects of wetland destruction will be too costly” published in the Daily Monitor, I noted that one of the underlying causes of this massive degradation is poverty which drives population to derive livelihood from wetlands, in this instance, by setting up a market in a wetland.

 

Whereas poverty is a social fact which will always exist, I proposed in the same article that the government and relevant stakeholders should strengthen the wetland community approach, resource user approach, and the ecosystem approach depending on the area of operation to cultivate practical community involvement in their protection. It is a myth to suggest that wetlands can be protected without the full cooperation of the community. We need to wake up and smell the coffee before wetlands come to extinction and our houses, schools, farms, villages, and towns become water catchment areas.  

While at this, the government should also desist from outrightly clearing projects that seek to acquire cheap and free land in the form of wetlands and forests without carrying out adequate assessment of the likely ramifications over the years. We do not need a job at the cost of massive degradation of the environment. A job benefits an individual but the environment is for all in the world.  

TOBACCO CONTROL FOR HEALTH BENEFITS AND NO HARM TO ECONOMY

On May 1989, the World Health Organization passed a resolution calling for May 31^st to be annually recognized as World No Tobacco Day (WNTD). This Tuesday being the 31^st of May, the world will mark this day amidst research findings that show that tobacco cultivation and consumption increases poverty, depletes national resources and is directly responsible for approximately 5.4 million preventable deaths worldwide annually arising out of related illnesses such as heart attacks, chronic obstructive pulmonary disease, emphysema, strokes and several forms of cancer.

Tobacco is a product of the fresh leaves of “nicotiana” plants. It is largely believed to have originated from the Americas and was introduced in Europe by Jean Nicot, a French Ambassador to Portugal in 1559 before becoming popular across the globe.

In May 2003, the 192 WHO member states unanimously adopted the “Framework Convention on Tobacco Control” (FCTC) which expressed firm commitment to address public health challenges posed by tobacco consumption.

Approximately 60% of the 5.700 billion cigarettes smoked annually and close to 70% of tobacco users are residents of developing countries. Research indicates that over the recent decades, tobacco use declined in many high-income countries which is food for thought for developing countries. 

It is however disconcerting to observe that whereas contribution of tobacco to death and disease is quite well documented, less interest is repeatedly accorded to the ways in which it in fact amplifies poverty. Scarce family resources are used up to buy cigarettes daily instead of supplementing indispensable needs such as food. A recent study conducted in Bangladesh indicated that if two-thirds of the money used to purchase cigarettes was spent on food instead, over 10 million people could be saved from malnutrition.

As expected, WNTD is often faced with resistance. Certain groups feel the day is a plan to unfairly single them out and challenge their rights. Some construe the day as a challenge to individual freedom of choice and a form of discrimination. In response to WNTD and a statewide ban on smoking in certain places, a group in Honolulu, Hawaii by names of “Americans for Freedom of Choice” organized a “World Defiance Day”. Tobacco growers and their associations feel that anti-tobacco efforts jeopardize their economic rights and insist that poor farmers in Africa will suffer should WHO efforts against tobacco succeed. 

The World Bank after exploring the economic dimensions that need to be addressed while effecting tobacco control, released a report that meticulously and technically crushed assertions that there will be a huge economic loss. Such assertions have dissuaded policy makers from taking vital steps.

Research further reveals how much tobacco growing leads to the degradation of the environment and deforestation as a consequence of fire curing of some types of tobacco. To compound this already seemingly appalling state, most communities that deal in tobacco growing often employ child labour since it is exploitable. 

There is an ever increasing need to protect Uganda’s teenagers and young adults from getting addicted to tobacco by regulating the tobacco industry and funding initiatives that seek to break the chain of smoking among the addicts. It is old news that for the tobacco industry to survive, it must hook new customers to replace those who quit or die. The younger children are when they first try smoking, the more likely they are to become regular smokers and less likely they are to quit. 

This World No Tobacco Day, let us discuss policies that can save our youths from becoming addicts and the implementation of better tobacco control systems.    

  

Masake Anthony

The writer works with ULS

mskmas@yahoo.co.uk

UGANDA & FGM: We Need To Change People's Attitudes

 ACCORDING to the World Health Organisation, about three million girls in Africa are at risk of undergoing female genital mutilation (FGM) annually.

Already 92 million girls aged 10 years and above are estimated to have undergone the practice. In Uganda, FGM is practised in Kapchorwa, Kween and Bukwo districts in the Sebei region.

FGM leads to several complications such as increased risk of complications during child birth.

But before we focus on the approach to eradicate FGM, it is imperative to appreciate the various reasons why it is practised in the first place. Some people believe that the clitoris and the labia are male parts, thus the removal of these parts enhances the femininity of a girl. Others believe that FGM reduces a female’s libido, thereby reducing their chances of having extra-marital affairs, hence stable marriages.
Some people also believe that an unmutilated female is unclean and should not handle food or water.

Others say unmutilated females are not fertile and, therefore, cannot conceive. Other people also believe that if a baby’s head or a man’s penis comes in contact with the clitoris, they will die. Other people believe that leaving a woman with a clitoris can lead to lesbianism.

For whatever reason, FGM is a cultural identity practice. The procedure is carried out to initiate a girl into womanhood. It is so ingrained into the cultures that practice it that they believe that banning FGM will lead to the demise of their culture. In order to curb the practice, we must eliminate the cultural belief that a girl will not become a woman and have all the benefits of womanhood without undergoing FGM.

All avenues must be explored in the fight against FGM to trigger massive awareness if we are to change people’s attitude.

Crowd-sourcing information on FGM by tracking voices of the poor girls who are shouting for our help and other members of society who support elimination of the practice is crucial.

The writer is a human rights activist

MASAKE ONLINE: ESTABLISH A SALARIES COMMISSION URGENTLY

MASAKE ONLINE: ESTABLISH A SALARIES COMMISSION URGENTLY: ESTABLISH A SALARY COMMISSION URGENTLY When a senior medical doctor dreams of applying for a job to become a driver to the KCCA’s Executiv...

ESTABLISH A SALARIES COMMISSION URGENTLY

ESTABLISH A SALARY COMMISSION URGENTLY

When a senior medical doctor dreams of applying for a job to become a driver to the KCCA’s Executive Director, you do not need a space scientist to illustrate to you how the teachers’ strike is not really about the teachers pay. In the larger part, the teachers’ strike is and should be treated as a symptom of consequences of glaring disparities in salary structures in this country. The issue is not the availability of money in government coffers but rather the unfair imbalance in salary structures being compounded by unprecedented skyrocketing inflation. While others are handed blank cheques to blast away, others are condemned for demanding a meager increment in rather disappointingly, the understandable language: strike.      

We must find a credible solution which is better than just raising salaries in the proposed three year phase. Further, we must ensure that our economy doesn’t become a victim while at it because then, the money will be of less value thereby not solving the problem.

In 2010, Prof Augustus Nuwagaba while on contract from the Ministry of Public Service to develop a policy paper for the transformation of the Uganda public service, among other key recommendations; he proposed the establishment of a salaries commission with a specific objective of streamlining the salary structure in the country. What happened to this great idea? Does it also need billions like the university student loan scheme and other wonderful programs to be implemented? Or is it just a case of corn expecting justice from a court composed of chickens?

Of course, the operationalisation of an independent salaries commission is not in everyone’s interest. There will be losers and winners. However, we need to look at the greater common good. It is the only way we can restore not only order in public service salary disparities but also the zeal to deliver quality service which is now deadened.

Putting the crisis in context; going by the press reports, the driver to the Executive Director of KCCA earns in one month what a primary school teacher earns in around 25 months while a member of parliament earns in a single month without other allowances what a primary teacher earns in 47 months. At the end of the day, they all go shopping at the same market. This is shameless and despicable.

The government is proposing alternative ways of resolving teachers’ grievousness along side salary increment such as funding a teachers’ cooperative and building teachers’ staff quarters on grounds that these are one-off expenditures as compared to monthly salaries. Whereas these are viable options and infact brilliant, emphasis needs to be placed on the urgency of the establishment and operationalising an independent and transparent salaries commission as soon as possible. The beauty of such a commission is that the available resources in the economy will be equitably shared basing on academic, experience, and other valuable criteria. 

Among the guidelines in the new-look salary structure which the commission would come up with, we would have measures such as no government employee should earn more than 12 times what the lowest paid employee earns in a single month. To put it in another way, if the lowest paid employee earns let’s say UGX: 500,000/= per month, then the highest paid employee should not exceed UGX: 6,000,000/=. In addition to this pay, they would then receive modest benefits and allowances which are strictly relevant to their specific duties and prevailing economic circumstances.

The government can order employees to their respective work stations at best but cannot force them to deliver quality service and needless to add, such a nation can then forget about development. We need to stop playing hard expecting things to get better because that is a place for optimists. We need to be realistic and start acting now to avert the looming multi-sectoral strikes, worse inflation, and possible result of famine.