In Summary

Finding options. With most of the health facilities lacking adequate personnel and the required medical equipment, most affected people -- the peasants -- decided to take control of their development affairs.

The experience she goes through is beyond her imagination.
Just in her early 20s, Vistine Kemigisha is already dealing with situations that even an experienced midwife would not wish to face.
“I remember a day when I assisted a woman to deliver in a facility that didn’t have any equipment. Not even light. Yet it was late in the night,” Kemigisha, a young midwife in Kabale District, told the Saturday Monitor.

“This woman was brought to the health centre by a group of six young men, who had each carried her in turns on their shoulders.”

In her attempt to help the woman deliver and save her from the excruciating labour pains, Kemigisha reached for a lantern only to discover it didn’t have paraffin!

“At that point I almost fainted. It was dark, but despite the situation, I had to do everything possible to help the woman who was now already helpless,” said the young Kyego Health Centre midwife.

She impulsively reached for her phone which had a torch, put the light on, clenched it between her teeth and got to work - helping the expectant mother whose delivery time was already due.

Prayer
“I have never prayed so many times,” she said. “In this condition I prayed for my phone not to black out and also that the delivery does not get complicated because there was no senior medical personnel. Part of me was also scared of the young men who brought the helpless woman -for I had just heard a story of a woman who was raped by a group of young people recently.”

Vistine’s story is not unique where the doctor to patient ratio is beyond the expected average.

For example at Lapainat Health Centre in Gulu, the Saturday Monitor found just one doctor attending to over 100 patients. Most had been at the health centre long before sunrise, but by 2pm, many chose to return home without seeing the doctor.

Those, who were too weak to help themselves, were lying all over the hospital floor unattended to.

“I can only do so much,” said Dr Miria Aketch, who had attended to several patients since morning without a proper break.

Her appeal was: Give me facilities and human resource—and you will not find patients littered all over the floor as it is the case now.
These conditions largely sum up the story of health services in the rural areas—from the doctors to midwives, they all grapple with the same kind of predicament as they execute their professional duties across the country.

With most of the health facilities lacking adequate personnel and the required medical equipment, largely due to poor maintenance and negligence of the local or district officials, who most of times prefer to pre-occupy themselves with little political fights, the most affected people -- the peasants -- decided to take control of their development affairs.
These rural folks rose up to put things right.

Initiative
Forming themselves into a group of about 20 men and women, they are more determined and prepared to change the rules of the game from the “usual” way to the “right” way of doing things.

Through this initiative, they have managed to identify problems with health centres such as unauthorised selling of drugs and mama kits within the health unit, unqualified health volunteers demanding payment, drunkard midwives all of which discourage women from accessing maternal health services.

“It is no longer business as usual,” said Ms Sarah Basiime, one of the Village Budget Club (VBCs) chairpersons.

In a recent interview with the Saturday Monitor, Basiime said the emergence of VBCs in several villages in rural Kabale has contributed to ensuring that health facilities have drugs and delivery rooms have lights and all other necessary equipment.

And there are health practitioners in all health facilities around. And because of these demands towards the local and district leadership, the members of these groups have tended to be a little unpopular with the powers that be even if their mark on the ground is almost indelible.

Presently, the VBCs pressure has seen the Kyego maternity ward a little improve. And because of VBCs habits of following up of matters to their logical conclusion, the district leadership has since promised to turn around the face of Kyego health care centre, including fixing the bridge leading to the health centre that had broken down months ago.

“We are aware of the challenges in most of these villages. VBCs have done a good job and because of their pressure and interactions, so many things have been fixed,” Winifred Busingye, the Kabale District Community Development officer, said in an earlier interview.

James Mugisha, the assistant Chief Administrative Officer, told this newspaper that some of the district’s budget, worth about Shs35 billion, would be dedicated to improving the health centres, Kyego being one of them.

Although Mr Mugisha argued that sometimes the VBCs demands are misdirected, citing a case where they make duty bearers explain why a road managed by UNRA (a government road) is not in good shape, he has overall appreciated the work of the women and men who voluntarily work to ensure government resources are not mismanaged.

“VBCs supplement our work. And I think without them there will be a gap created,” he said.
Origin of VBCs
The VBC concept was developed by FOWODE to promote gender accountability from grassroots to the national level.

To date, the rural communities and its leadership agree that it has transformed lives and provided space for communities to interrogate and debate the local government planning and budgeting process.

Three VBCs have been established in Kabale, Kibaale, Kibuku, Napak, Amuria, Amuru, Kotido, Kitgum, Abim, Busia, Lyantonde, and Masindi District.
Luwero, Mityana, Wakiso and Gulu also have the groups.

Each club is composed of 20 members, 12 of whom are women, who have been mobilised and trained in gender budget monitoring and service delivery tracking within the community.
The trainings equipped them with knowledge and skill to begin questioning how resources are mobilised and allocated and whether the allocation criteria address the needs of poor women and men in that particular community.
iladu@ug.nationmedia.com