Aug 14, 2012

AMREF's approach to Maternal and Child Health

An AMREF midwife at work
An AMREF midwife at work

Though AMREF brings health and hope to all African families in need, beginning in 2010, we made a conscious decision to focus more heavily on maternal and child health. Currently, we are hoping to make the most impact in the Millennium Development Goal #5 (improvement of maternal health).

What women in the developed world take for granted - skilled midwives, an obstetrician and operating theatre if needed, and the antibiotics and drugs to ensure that should complications arise, the mother is rapidly brought back to good health – all these apparently basic things, are great luxuries in Africa.

In particular, women in poor and remote communities, far from the nearest health services are most at risk- with young women and girls are in the most danger. In many communities girls still marry at very young ages and contraceptive advice is poor or non-existent. Many of the worst complications in pregnancy are suffered by teenage mothers; giving birth is a physically traumatic experience for a girl whose body is still developing.

Based on current trends, Sub-Saharan Africa will not attain the Millennium Development Goals (MDGs) by 2015. MDGs 4 and 5, to reduce maternal and child mortality and morbidity, are those towards which the least progress has been made. At the current rate of progress in Sub-Saharan Africa, MDG 4 to reduce child mortality will not be met until 2165 in Africa. Evidence suggests that over 60% of deaths in children less than five years old could be prevented by existing interventions. Of deaths in new-borns, 41 to 72 % are preventable using a high coverage of available interventions. Half of these deaths could be avoided through the use of community-based programs. MDG 5 which aims to “improve maternal health” is desperately off-track. The shortfall in funds to meet the MDGs for maternal and child health amounts to only 2% of current development aid – a small fraction of world spending. Yet investing in women and their health strengthens families, communities and countries. Family budgets, local productivity and national wealth all flourish where maternal health is prioritized. In many countries, weak and fragmented health systems, and in particular inadequate human resources do not permit the scaling-up of crucial interventions for maternal, new-born and child health.

To fight for more skilled medical training and assistance for women in Africa is not only a justice battle or an ethical need. It is owed to present and future generations for a fair and sustainable economic and social development, it is part of our common survival, and it is a gain for our intercultural world that we hope for. We need to support the creation of healthy conditions for women and children which deserve their full dignity to continue their contribution to life.

177,000 mothers are dying each year in pregnancy and child birth in Sub-Saharan Africa and the chances of dying are actually going up in some countries. But, it does not have to be this way; most of the deaths are avoidable. Simple affordable training and equipment saves lives and ensures that having a baby is a time of joy for the whole family.

AMREF is already working hard to help mothers. Our conviction is that there is now an urgent need to do more. It is simply unacceptable that more women will suffer and die when simple affordable solutions are at hand.


Apr 19, 2012

Building the Capacity of Health Workers Project

Making pregnancy safe and expanding reproductive health services in Uganda



James Kainerugaba lives in Kirowooza Village in Kakooge sub-county, Nakasongola District. Being a pastor of the Kakooge Full Gospel Church, James is well known, trusted and respected in his community. Because of his approachable and dependable nature, and his good communication abilities, James was selected by his community to be a member of the Village Health Team. The single 30-year-old farms for a living, but he has programmed his time so that he gives ample attention to all his responsibilities.

James is one of five VHT members in Kirowooza village, which has 135 households. “I have been a VHT member for the last 12 years. My main role is to identify and link the people in the community to the health centre.” James has had a long relationship with AMREF, which supported his education through a programme that ran many years ago, after which he joined a youth group supported by AMREF. “We were given a lot of health education, which helped me understand that most health issues can be dealt with at community level,” he says. James and his fellow VHT members have received refresher training from AMREF on malaria, HIV, mothers’ and children’s health, nutrition and family planning. “This training has made me more confident and motivated because I have information that I can share with my clients. You know, you cannot give what you do not have. This training is very important to us because when we talk to the community, they listen.”

One woman who listened to James is Jesca Nzamukosha. The 35-year-old mother of six had her first three children at home, but the youngest three were delivered at the Kakooge Health Centre. “Before AMREF started working here with James, most of us had our babies at home,” says Jesca. “We were not tested for HIV or malaria, even when we were pregnant, because very few of us ever went to the health centre. We did not know how important it was for us to be checked. I have learnt a lot from James about nutrition and hygiene. I also have a mosquito net to protect me from malaria. Before James talked to us, my husband and I never discussed HIV, but now that he has given us all the information, we talk freely, and we even know our HIV status.” James is proud of the work he is doing in his community. “We are able to handle all sorts of issues, even sensitive ones like male circumcision to reduce the risk of HIV infection. Mothers and children are healthier than before. Just visit any health facility and you will see the increased number of pregnant women there. This is because of our referrals.”




  • Nakasongola District has a population of 146,000 with a distribution that is typically young – 50 per cent are under the age of 15 years.
  • The Maternal Mortality Ratio in Nakasongola is 650 deaths per 10,000 live births, compared with the national figure of 435 deaths per 100,000 per live births.
  • The population served by VHTs is 13,631 in the Nakitoma and 46,077 in Kakooge sub-counties.
  • AMREF has trained 395 VHT members in 79 villages in Nakitoma and Kakooge.
  • Nakasongola District has an infant mortality rate of 67 per 1,000 live births, compared with a national figure of 76 per 1,000 live births.Child mortality is 129 per 1,000 live births, compared with 137 per 1,000 live births nationally.
  • 78 pregnant women were referred by VHTs to the health centre in Nakitoma in 2011, compared with none in 2010, while in Kakooge, 70 women were referred in 2011, compared with five in 2010.
  • The number of people tested for HIV in 2011 was 1565 in Kakooge, and 1296 in Nakitoma. Of these 837 women in Kakooge and 311 women in Nakitoma were put on treatment to prevent mother-to-child transmission of HIV.
  • 5,323 nets were distributed in the two sub-counties in 2011.
  • In 2011, the number of women who received intermittent preventive treatment for malaria in Kakooge was 906 (IPT1) and 521 (IPT2), compared with 469 (IPT1) and 200 (IPT2) in 2010.
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