Maternal and child health programme saving mothers and babies in hard-to-reach areas of Acholi

For every mother and child, health

By Proscovia Nakibuuka Mbonye
UNICEF maternal and newborn health interventions in Uganda
01 July 2016

Uganda, Kitgum, 2016 - Lakicha Susan, a 20-year old mother cuddles her new born child, smiling spontaneously. She cannot hide her joy, it is her first child. The journey to delivering her bundle of joy was not very smooth. Susan was referred to Kitgum Hospital after health workers from her nearby health centre noticed her baby was very big, indicating she required advanced care, being a first time mother. 

Kitgum hospital is more than 80 kilometers from Susan’s home, Pora village, in Pader District in Northern Uganda. It is a hard to reach area and access to health facilities and services is a challenge, often leading to preventable deaths which result from labour complications.

I was very worried, I thought I was going to lose my baby. We had no money for transport or any means to take me to Kitgum Hospital yet I was already in pain (labour).


“It took us three hours to get to the hospital,” she reminisces. Luckily, upon referral, there was free local boda boda (motorcycle) transport provided by the health centre with support from the Korean International Cooperation Agency (KOICA) through UNICEF to transport Susan and her caretaker to Kitgum hospital.  

The voucher motorcycle transport system is one of the initiatives supported under the health programme, to address the second delay that occurs after mothers make the decision to seek medical care but lack transportation or lack funds to pay for transport to reach the health facility. The cyclists have been trained to support and manage any emergencies that may occur while as they transport mothers and children to the health facilities. “The transport voucher system is very good because it reduces the time a mother takes to the health facility,” says Alex Owor VHT member from Pora Village, Pader District. 

Susan is among many other women and mothers in the Acholi region, who have to trek long distances to access health services for themselves and their children. Despite the end of the prolonged insurgency in the region, the returned populations still have limited access to basic amenities, including health services.

Uganda’s maternal mortality (438 deaths per 100,000 live births) and under five mortality rate (90 deaths per 1,000 live births) remain high with both indicators being poorest in the Karamoja and Acholi regions.

With funds from KOICA, UNICEF is supporting a maternal, newborn and child health (MNCH) programme in the three districts of Acholi region – Kitgum, Pader and Agago Districts - to increase access to an integrated package of quality health services aimed at strengthening the continuum of care for high risk pregnant women and children with danger signs, from the community to the health centre.

The programme aims at addressing the three life-threatening delays which create barriers to accessing maternal and child services ultimately leading to maternal, newborn and child deaths.  

Alice Norah Abonyo, a mother of two who has also just returned from Kalongo hospital with a baby girl, affirms that the health facilities are indeed very far. She was also referred to the hospital when she suddenly had false labour pains as a result of severe malaria. Her home is 50km from the hospital. “I am really grateful for the continuous support from the Village Health Team (VHTs) members throughout my pregnancy.

I am also happy that we received free transport provided by the boda bodas. Because of that I was able to get to the hospital very fast and my baby was saved,” Alice mentions.

Both Alice and Susan were identified by a VHT who encouraged them to seek antenatal care and to give birth in a health facility.  

To address the first delay, that bars mothers from seeking medical care, the programme has supported the training of over 1000 VHTs who traverse communities to identify pregnant women and sensitize them on the benefits of attending antenatal care visits and delivery from health facilities.

The VHTs have also been trained to detect danger signs and make effective referrals of complicated cases of pregnant women and children to health facilities. “This has strengthened the referral system and significantly increased deliveries in health facilities,” Owor added.

“Prior to the programme, mothers delivering at the health facilities were really few, but they are now coming and as a result of the timely referrals, we have not registered any maternal and child death.” The VHTs also promote postnatal care and exclusive breastfeeding. 

In addition to creating sustainability and ownership of the programme, expectant mothers and other existing support groups in the three districts of implementation have formulated ‘Expert Mothers/Male action groups” that meet regularly to discuss and promote safe facility based deliveries, family planning, ante-natal care, post-natal care and emergency obstetric and new born care. The support groups have also recruited former traditional birth attendants who now advocate against home based deliveries.  

The KOICA support through UNICEF has also ensured that health workers at the lower levels and at the major hospitals in the region are trained to handle complicated cases. 

According to AVSI the implementing partner, 69 health workers from 33 health facilities have been trained on Basic Emergency Obstetric and Neonatal Care (BEmONC) and Comprehensive Emergency Obstetric and Neonatal Care (CEmONC).

The training has enhanced the skills of the health workers who are now handling complicated cases like preeclampsia and resuscitation of babies and supporting babies born with breathing problems. This has helped save lives of mothers and children especially those under-five years. 

Patrick Ojok, the Programme Officer from AVSI, is impressed with the progress made so far. He mentions that the programme has led to significant increase in the number of mothers attending the recommended four ANC visits from 34 per cent to 50 per cent; more than 1000 VHTs have been trained to identify and refer pregnant women and sick children to health facilities; they have introduced the voucher transport system for easy transfer of children and women with danger signs to health facilities at no cost and also trained boda boda cyclist on how to support pregnant women and children during transportation.  

UNICEF Programme Specialist, Dr. Rabbin Drabe, said the programme has generated demand for health services in the three districts as a result of the awareness created by VHTs, the frontline health contacts in the communities. As a result of the great work, the numbers of four ANC visits has risen from 23 per cent to 45 per cent; there is also an increase in deliveries in health facilities from 36 per cent to 42 per cent and a reduction in neonatal deaths from 33 per cent to 23 per cent.

​​​The programme adopted high impact interventions aimed at improving the maternal and child health situation in the region, hence the great results. We are saving more and more mothers and babies each day.