Changing community perceptions on health care during pregnancy and at child birth at Mannya Health centre.

Mannya health Centre is mandated to serve a catchment population of approximately 17875 people who reside in Kifamba subcounty, Rakai District. In a 16-year period of operation, the health centre has aligned efforts to enable access to services of a primary health care package to all people in the area. Often times, efforts have been antagonized by several factors ranging from abject poverty, ignorance, contrary cultural & occasionally superstitious beliefs to resource constraints.

The health centre has been lucky to host many partners and win their support on a number of aspects in operating the health centre. The support ranges from infrastructure, staff salaries, equipment, drugs and other one-off donations to community empowerment & one-off treatment sponsorships for vulnerable. These play a role in keeping several services here at the health centre cost free and on some occasions with a very little cost. This goes a long way in keeping basic health care accessible to household’s majority of whom live off subsistence agriculture without any major income generating amenity in a home.

It was common in a number of households to handle some health conditions at home with the help of traditionalists like the Traditional birth attendants and herbalist. This was perceived to be a means of saving on the cost of transport and other costs related to going to the health centre. However, there was a much more cost hidden inform of disability, complications, death from a number of such conditions poorly managed outside skilled health care. For instance, Rakai was famous for reporting most fistulas at Masaka fistula centre in Kitovu VVF clinic.

According to the local government demographic indicators, 894 pregnancies and 867 deliveries are expected in Mannya Health centre catchment every year. However, in financial year 2016/2017 we only attended to 349 pregnancies in antenatal care and 398 deliveries. The numbers were even lower in previous years yet complications like death and fistulas were very common.

One of our mother champions so happy with the progress of her piglet in August 2022 during a monitoring visit by the vet officer.

The advent of a cost-free scan service during pregnancies in 2017 and later microfinancing scheme at house hold level is gradually changing the story for the better. Pregnant mothers feel confident with skilled midwives who regularly monitor the development of their baby on a screen. This experience for mothers appears to contribute to the steady increase in the number of women seeking antenatal care during pregnancy at the health centre since 2018, with financial year 2021/22 recording over 500 women. Several mothers have professed loss of trust in services of the traditional birth attendants who only use hands to monitor the baby and apply herbs.

The microfinancing scheme project for registered mothers is yet another window of opportunity to address the root cause of the poor health seeking behaviour, that is, abject poverty. In 2019, we received a grant worth about USD 4200 to invest in an income generating project at the health centre. The subsequent income would be used to microfinance piglet breeding project in homesteads for pregnant mothers. The criteria for inclusions were interest, commitment, willing to attend antenatal care and deliver at the health centre as well as, evidence of support from other members at home. Some of the income would also be used to maintain the scan, purchase gel for the scan, facilitate mentors from regional office and all other related expenses.

The grant was used to construct a rental house which was successfully completed in 2021. To date the income from the rentals is used to facilitate mentorship visits by the supervising sonographer, supervising agricultural extension worker and purchased 18 piglets for mothers’ home-based piglet breeding schemes. Many more mothers are excited to be enrolled on the project, this has made seeking health care during pregnancy at the health centre and consequently delivering at the health centre very popular in the community. In this vein we hope to transform health seeking behaviour for the entire community to promote public health eventually.

A 35-year-old female (prefers anonymity) residing at Kabala village in Mannya has recently shared her life changing story with us. She is a mother of 4 children who are all living. When she conceived the first time, 7 years ago, she was eager to start antenatal care at the health centre, since the midwife was always explaining the benefits in the local church. However, many of her colleagues discouraged her that the gods would not be happy with her if she never went to the traditional birth attendant in the area but she insisted.

According to her, the trust she had in skilled health care during pregnancy deteriorated when the midwife told her that she had a big baby who needed to be delivered by caesarian section. She then started confirming everything her colleagues had told her despite the midwife’s counsel. She regrated never going to the traditional birth attendant when she actually had a caesarian section.
On her second pregnancy in 2018, she had decided never to appear at the health centre but only be cared for by traditional birth attendant (TBA). She had previously feared TBAs after so many stories of pregnant women who had died at the TBAs home. But this time she had been assured that only the TBA has the charm to prevent subsequent Caesarian section for the new pregnancy.

One of our mother champions so happy with the progress of her piglet in August 2022 during a monitoring visit by the vet officer.

1st Batch of 9 Mothers receiving their piglets after training at Mannya health centre in June 2022Mid her second pregnancy the area Village Health Team leader visited her and talked to her about free ultrasound scan for pregnant mothers at the health centre. She was intrigued by the information and decided to make the first Antenatal visit with intention of getting a scan. The experience with the scanning motivated her to abandon the TBA care and continue antenatal care at the health centre for the rest of weeks of pregnancy. She was even happier when her scan late in pregnancy predicted that she would be able to give birth normally and indeed it happened. Since then, she has had 2 more children with the youngest 3 months old currently. By the time of the recent baby, she was already enrolled in the microfinancing piglet breeding scheme. She is currently our champion trying to bring more mothers from TBA care to skilled pregnancy and birth care at the health centre. She is hopeful that the project will greatly supplement income at home and facilitate future pregnancies.