Teddy 24 yrs mother of 2, is 7 months pregnant with her 3rd child, she delivered her 2 children at home. This time she is determined to deliver at the health facility.
Teddy walks 13 kilometres from Gung Gung village to attend her ANC at Koch Li Health Centre III. The day she is to attend ANC, she is on the road by 5 am so that she can make it on time by 10am, be attended on time and by 1 pm she starts on her return journey home.

Likewise, Concy 34 is a mother of six children. She lives a kilometre away from Angaya HC III in Loyoboo village in Unyama sub county, Angaya parish. Her 3 months Calvin was born at Angaya health centre in June 2021 weighing 3.3 kgs. All her babies were also delivered normally at health centres.

Most of the mothers I interacted with at health facilities and in the community confirm that the attitude of midwives has greatly improved, an issue that previously made them shun health facilities. They say nowadays health workers are very welcoming and are available all the time to assist mothers deliver.

Mothers say they are encouraged to deliver at the health facility unlike in the past when midwives were rude to mothers. Midwives today give special care to pregnant mothers especially those coming from faraway places who arrive with nothing, Concy reiterates, “when you arrive, you are given charcoal to prepare meals.  After delivery, you are given sugar, a mosquito net, a bar of soap and a basin. At times we also provide mothers with chlorixidine free of charge to mothers to clean their babies’ umbilical cords continues, Concy, midwife.

Health workers also confirm the incentives (bought by RBF funds) given to mothers have attracted more mothers coming to deliver at the facility. They demonstrate that with results based funding, midwives are given incentives depending on how many mothers they have attended to, so they had to change their attitude in order to attract more mothers coming to the health facility. Peace midwife reinforces “the incentives provided to us is a positive driver, when you know you are going to get an incentive, there is away you treat mothers too so that they come in big numbers”. The DHO Amuru District Patrick validates the change in attitude of midwives in handling mothers.

With additional RBF funding, some health facilities have improved conditions for mothers and their attendants, case in point, Angaya HC III has constructed a comfortable bathing shelter for mothers and their attendants. There is also a cooking shade for attendants where the facility provides free charcoal, a stove and a kettle. This issue had come out during community dialogues where communities complained about the lack of a bathing shelter at the facility and the delays mothers go through at the facility.

According to Peace Maria, midwife at Angaya HC III, she says, facilities have devised several modalities to attract mothers to facilities. They track pregnant mothers from multiple entries (OPD, Maternity, ART and during community outreaches. “We start all the way from OPD, we tell mothers that once they miss their period, they are booked for ANC. This is because we want mothers to test within the first 12 weeks and advise them on the subsequent ANC visits”.

Additionally, when health facilities organise community outreaches, they identify mothers who are almost to deliver and attach them to VHTs for monitoring. Similarly, VHT members during their family visits in the communities, they identify and encourage mothers to go for antenatal and to deliver at the health facility. Kenneth a VHT member says they advise mothers as soon as they confirm they are pregnant to come to the health centre for ANC and it is while attending the ANC that we advise them to deliver at the facility.

The Health Sector Performance Report 2020 indicated a decline by 3% (59% in 2020) from (61% in 2019) out of the deliveries conducted at health facility deliveries, still far below the HSDP target 89%. We are optimistic the practice of every mother delivering at the health facility with the help of a medical worker will continue. When they deliver at the health facility, they will be advised on the best nutrition and in the long run Uganda to attain a healthy and productive population by 2040 that effectively contributes to socio-economic growth.

Enabel is supporting 38 health Centre IIIs, IVs including general hospitals in the districts of Gulu, Gulu City, Amuru, Omoro and Nwoya.  With additional funding, health facilities have invested the funds to address among other issues, the low motivation of health workers by providing staff incentives, poor infrastructure, frequent drug shortages and the inadequate medical equipment.