Learn how, with a blend of tradition and technological innovation, Uganda is pushing ahead to reduce child mortality.
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By Sarah Crowe
The 2013 Progress Report on Committing to Child Survival: A Promise Renewed shows that major progress has been made in lowering child mortality in all regions of the world and at all levels of national income. Nonetheless, even bigger gains are needed if the world is to meet Millennium Development Goal 4 – reducing under-5 mortality by two thirds by 2015. UNICEF’s Web series on A Promise Renewed focuses on some of the successful and innovative programmes that have helped save the lives of millions of children around the world.
A blend of tradition and innovation has helped make a drastic difference in the survival rate of Ugandan children, over the past generation.
BUKUMANSIMBI, Uganda, 16 September 2013 – In Butenga health centre, 4-day-old Brian has become one of Uganda’s newest citizens. Five other babies were born here this week – that’s five times as many as just a couple of years ago.
Getting help in time from a skilled birth attendant helps babies graduate beyond the most fragile moments in their lives and helps mothers cope better from childbirth. The reason for the boom in births is growing use and demand for better health services, which is all aimed at cutting preventable child deaths.
Old and new
With a mix of the traditional – organizing community dialogues – and innovative ways of using modern technology, Uganda has made impressive cuts in the number of child deaths over the past generation.
“Opening up community dialogues, in different areas, in different parishes, has helped,” says Senior Clinical Officer of Butenga Health Centre Dr. Wassua Timothy Bukenia. He explains that health workers participate in dialogues with the community. The workers answer questions and talk about the services the health centre provides. “Initially, [the community] used to call it the ‘government health facilities’, but we told them this is your centre because the services are there for you, not for the government, but for you,” says Dr. Bukenia. “So the community came in to test the services, and they were impressed – and, from that time, we started seeing numbers rising up.”
Another big game changer for Uganda has been the introduction of mTrac. mTrac is a new rapid SMS system, originally developed by UNICEF, and now one of the leading government-led mobile health initiatives. It takes advantage of growing mobile phone ownership rates in Uganda to complement the existing health management information system (HMIS).
Through the toll-free mTrac SMS hotline ¬– 8200 – any community member can report health service–related issues. The service is now available throughout the country – and millions of mobile subscribers have used it.
Nakimbugwe Juliet and her 2-year-old daughter Violet, at Butenga Health Centre, where rapid SMS technology mTrac is being piloted. mTrac and other innovations are helping improved health care to reach remote areas of the country.
Drugs on shelves, by dashboard
One application of mTrac has been to report when essential drugs are out of stock in hospitals. mTrac features standardized drug management and operations. In just a click, depleted drug stocks can be replenished by notifying the central district through a dashboard. This process saves time, fuel and money – and patients are not turned away because of lack of drugs.
“Previously, if a facility had a drug stock-out, they would have to wait three, four months for the next drug supply,” says Health Systems Specialist for UNICEF Uganda Dr. Davis Musingizi. “Right now, the district can look at his mTrac dashboard and identify which facilities have sufficient and which ones have a stock-out.”
“We are no longer experiencing wastage of drugs,” says Dr. Bukenia.
Video to Karamoja, in Karamoja language
It’s all starting to give Uganda a reputation of being something of a laboratory of change for children. In one ramshackle warehouse, a team of technophiles are developing another prototype. Under cover of a suitcase with wheels, this new machine beams health messages out to remote rural areas, like Karamoja, in the northeast. The first field tests have been promising.
“The people there were totally amazed,” says Hartmut Androsch, who is Technical Coordinator for Technology for Development, UNICEF Uganda. “It was the first time they had seen something like that. First of all, many have not seen something like a healthcare video – and then we even had it in their own local language, Karamoja language.”
Basic nuts and bolts of care
There is tangible energy and excitement for rolling out new ideas for children’s health in Uganda. But, at the same time, health experts are keeping an eye on balancing innovation with the basics. With Uganda’s rapid urbanization and its third highest fertility rates in the world, volunteers from village health teams are on the front line against the big killers of children, such as malaria, pneumonia and diarrhoea. They explain the importance of sleeping under a bed net, teach good nutrition and hygiene and promote cheap, simple solutions like hand-washing with soap.
Nursing officer Nalutaaya Pauline sends an SMS via mTrac. Health workers can use mTrac to track health-related information, including drug stocks and disease outbreaks, in real time - and register births.
One successful programme – Saving Mothers, Giving Life – integrates interventions for child and maternal survival, including mobile health solutions. Hundreds of health workers in Uganda and Zambia have been trained to provide emergency obstetric and newborn care. Community health workers provide support for birth preparedness, as well as for collecting data to track progress. Essential supplies and equipment, including ‘Mama Kits’ and medical toolkits, are provided to promote safe deliveries in health facilities.
“It’s a lot of the basic nuts and bolts, frankly,” says Leslie Reed, Mission Director of USAID Uganda. “It’s sanitation, water, electricity, it’s staff, it’s access.
“So I think it is going to be a shared commitment, and we really need the Government of Uganda to really step up. They have an excellent plan, and we need to be working together to implement that plan.”
Uganda is due to launch its plans for implementation in November 2013.
A Promise Renewed is a movement based on shared responsibility for child survival, and is mobilizing and bringing together governments, civil society, the private sector and individuals in the cause of ending preventable child deaths within a generation. The movement seeks to advance Every Woman Every Child — a strategy launched by United Nations Secretary-General Ban Ki-moon to improve the health of women and children — through action and advocacy to accelerate reductions in preventable maternal, newborn and child deaths.
Since its launch, 176 governments have signed the Committing to Child Survival: A Promise Renewed pledge, and thousands of civil society groups and private individuals have mobilized actions and resources in support of the goal. A diverse array of governments are setting bold new targets for maternal, newborn and child survival, while, around the world, civil society is increasingly holding governments accountable for their promises, facilitated by new communication technologies and tools.
A Promise Renewed recognizes that leadership, commitment and accountability are vital if we are to end preventable child deaths. And because child survival is increasingly recognized as a shared responsibility, everyone has a role to play.