Not business as usual: Make health facilities in Uganda friendly for the women with walking disabilities
It is very important for us to remember our commitments towards health care delivery like equitable health systems. Most efforts to improve Maternal and Newborn Health (MNH) outcomes in Uganda have focused on access and quality of care for women in general, paying no attention to special populations like women with walking disabilities with a high likelihood of poor MNH outcomes.
Rebecca Racheal Apolot
Makerere University School of Public Health are members of the Future Health Systems consortium. As part of a project funded by RinGs we have had an opportunity to listen to the voices of the women with walking disabilities during meetings with the community in Kibuku district-Uganda as part of a community scorecard project. The experience shows that the MNH needs of women with walking disabilities have been given very little attention. Approximately 12.5% of the total population of Uganda is living with one form of disability. Given that 51% of total population is female, disabled women would therefore account for approximately 6.25% of the total population. There are 1,578 physically disabled people in Kibuku district of which about 789 of these are women. Somebody might say these are few, but where have you forgotten your equity lenses? They may be few but they are contributing to the maternal mortality of Uganda, which is at 336 per 100,000 live births. We should remember that the fertility rate of the women with disability in Uganda is 6.3 while that of women without disability is 5.6; these statistics speak volumes, let’s not bury our heads in the sand, let’s face it and sort it.
In the public health facilities especially in the rural districts like Kibuku, which might be the case to an extent in some urban districts, there are no provisions for facilities to cater for the women with walking disabilities. Let us look at the MNH needs of a woman with walking disability from the time she is getting into a health facility; there is no ramp she has to crawl up the steps with such difficultly to access the facility. When she gets in, there is no seat suited for her height, so she has to seat down on the often-dirty floors to queue as she waits for the service. When she is called to the examination room, the bed is too high for her to climb so she will be examined on the floor where other mothers and midwives walk with their shoes (often dirty floors). Then the mother feels like a short or long call and goes to the sanitary facilities, there is not one room with facilities for the disabled so she crawls into the soiled shared latrines with her hands and knees. If the mother came to the health facility for delivery, the delivery bed is too high for her to climb so the midwife must carry the mother unto the bed (but how easy is this for the midwife?). The resting beds after delivery are equally too high for her so she will lay her bed on the floor to take a nap with her newborn while other mothers are on the comfortable facility bed. How about the midwives, do they know what the needs of the disabled women are and how to handle them?
The voices of the women with walking disabilities in Kibuku district-Uganda
“I was asked by the health provider to go to the examination room for checking but the bed there was too high. I could not climb it by myself”.
“Our health facility does not have separate places of convenience for the disabled people. I used to go to those available but I would often find them dirty … but I had nothing to do. I would still crawl in that messed up place like that”.
“I went to the midwives for help because I feel a lot of pain in the hip joint. They simply rubbished it off and said it is because you delayed to go for an operation that leg would have been put right, so just remain with your situation”.
What does it mean having no ramps, seats, examination beds, delivery beds, and maternity beds and latrines adapted for the disabled women in the public health facilities and midwives being rude? The women with walking disabilities will see no benefit in seeking MNH care at the health facility since a nearby Traditional Birth Attendant (TBA) might be a better refuge. The TBA is very close, the latrine is not adapted to the disabled but at least clean with few users, she is extremely friendly to the mother and they will deliver from the a ‘clean’ floor. This will contribute to maternal and newborn deaths that could otherwise be avoided if we acted on our commitments and promises.
Leadership at Ministry of Health, districts, health facilities and sub-counties should look into innovations to provide ramps, seats, beds and latrines for the disabled. The innovations don’t actually need a lot of money from the budgets; it is just prioritization and using the resources we already have to serve all people equitably. If we have four latrine stances in the health facility, lets modify one to have rails for disabled support. Carpenters and welders around us in our trading centers can make climbing supports for our beds at very reasonable cost. Midwives can be given continuous medical education session on handling women with walking disabilities without warranting training allowances. It doesn’t have to be big budgets; it got to be prioritization. We need to prioritize the needs of the women with walking disabilities to make our celebrations more inclusive, let women with walking disabilities in Uganda also say ‘YES IT IS INDEED WORLD HEALTH DAY!
This blog was first published on the website of the Makerere University Centre of Excellence for Maternal Newborn and Child Health.