Mifumi Health Centre
Securing the basic right to health and wellbeing for the rural poor
A major barrier for women’s health is inequality, both between men and women and among women in different geographical regions, social classes and indigenous and ethnic groups. These are rooted in social, economic or structural determinants such as unequal access to material resources, inequality in childhood development and barriers to primary and secondary education.
To improve women’s health, MIFUMI addresses issues related to reproductive health, maternal deaths, malnutrition and non-communicable diseases; through quality and affordable health services under universal health coverage.
Over the last 20 years that MIFUMI has been delivering domestic violence services, the organisation has witnessed the increasing emergence of domestic violence as a health issue that has implications on entire communities and the national economy at large. Issues beginning to become apparent in our geographical areas of work include the following;
Reproductive health: Sexual and reproductive health problems are responsible for one third of health issues for women between the ages of 15 and 44 years. Unsafe sex is a major risk factor particularly among women and girls in the Mifumi area.
Maternal health: Many women are now benefiting from massive improvements in care during pregnancy and childbirth introduced in the last century. These benefits however do not extend everywhere. Many women died in Uganda from complications in pregnancy and childbirth. Most of these deaths could have been prevented, had access to family planning and some quite basic services were in place.
Background to Mifumi health services for women
Mifumi Health Services Centre was established in 2000 when the need for a health facility prioritising the needs of women became paramount in MIFUMI’s domestic violence and abuse response work.
The facility designed services to meet the immediate health needs of women and other community needs such as access to certain quality services close to them.
I remember prior to this facility, many of the patients who have accessed this facility for the longest for the time told me of how they had to go all the way to Mulanda which is almost 9 or 10 kilometres away or go to another District called Busolwe. When you travel these long distances with a patient the outlook is not good. Grace- Comprehensive Nurse at MHS
Kawunya Mathew, a Clinician at the Health Centre says community service is at the core of the facility’s service provision.
We are continually sensitive to the community needs. We especially prioritise the needs of women. Some of our services are charged for to cover some administrative costs. However, these are not written in stone because we are conscious in our everyday practice that the service is designed for the community’s poor. We have assessed certain situations and on many occasions waived fees like consultations. We would like the community to know that the service was brought here, close for them.
Today the Health Centre provides quality services for women such as:
- Reproductive healthcare Services
- Antenatal care (ANC) and Postnatal care (PNC) services
- Health outreaches with support from Village Health Team (VHT) Volunteers in mobilisation of communities to access services at this facility and conduct follow up with members already accessing services; all geared towards reducing mortality and morbidity especially amongst mothers and children.
A sustainability measure is inevitable in advancing and continuing this service at an affordable rate for the community, Bernard Owor believes a move towards self-management and sustainability without compromising the quality of services to the community could be achieved if in the near future energies were focussed towards mobilising resources.
After 7 deaths, our first and most helpful diagnosis and support came from this Village health centre
With my husband’s job as a chef at a local restaurant we could hardly make decent finances to support the medical and healthcare of our ailing children. The challenge is we did not know what was happening to them and didn’t understand why after a short illness, they suddenly died in infancy. We spent hundreds of thousands on rituals to break bad omens. When we could no longer afford life in the city we returned to the village. It continued until we visited Mifumi Health Centre that for the first time the medical personnel in charge of the facility told us our children had actually succumbed to Sickle Cell. We lost 7 of our children. The health centre continued to support us with counselling and ran tests on our only child. The test confirmed he was a carrier like me and his father.
The children to my husband’s brother were presenting the same symptoms as ours and we linked them to the Health centre where they are now receiving medical care. We trusted the health centre to support them properly and quickly when they had emergencies and they have done so.
Compared to other facilities which I have visited myself, these workers have good relationships, they talk to you, they explain to you the problem properly in the local language until you understand. They counsel also and they send the VHT to follow up to check on the patient if you stay near. My whole family comes here for general medical care.
Especially for us women, I think MIFUMI did a good thing to put up this facility. Many of my in-laws’ and neighbours’ children were born here.
I can now only imagine those days when the nearest Health centre was many kilometres away and rushing with an emergency on a bicycle was risky for both the patient and the rider.
-Mary Achomo, Mifumi Village
MIFUMI observed that in most rural communities where the organisation’s services are established, women have disproportionately lower access to health services compared to men. In order to place a significant dent into the prevalence of domestic violence, an approach across multiple levels and sectors of society is necessary, and that includes health access.
Challenges to accessing care
Obtaining proper treatment for chronic diseases and other health issues becomes difficult when people lack access to health care. Women without health care coverage often receive a lower standard of care and have poorer health than those in cities.
Health Services Quality
Leading in quality health service provision
Mifumi Health Services emerged best performing in Tororo District last financial year after scoring a 90.6% on the District Local Government set catchment area and target population reach.
Each year, the District Local Government set a target reach for health facilities. In the past financial year, Mifumi Health Facility had a catchment area of one Parish to cover and a target population of 6,523 to reach.
According to Bernard Owor, The Health Centre’s Administrator, this is just one of many exemplary milestones of this facility. Bernard adds that such continued strife for excellence is the likely reason the facility is considered a model centre by Tororo District Local Government (TDLG) for learning and student placement.
The Health Centre has been a model facility to the District. Whenever Tororo District Local Government receives visitors from the Ministry of Health,this facility will be listed for visitation; medical students from tertiary institutions will also be attached to this facility for learning. Also this facility does not have tendencies of staff absenteeism or absconding of work like it is in other facilities of this nature and I think it is our databases of HMIS that make it a model Centre because there is always an electronic track record of what happens here on a monthly and annual basis… Yes we do have challenges like any Ugandan health facility but we strive for excellence and accountability in serving our community.
Bernard further explained that at the moment the Health Centre is reaching far beyond its set District catchment. Whereas it is supposed to serve only one Parish, which is Mifumi village, the health centre has people coming in from sub-counties such as Nabuyoga, Nagongera, Mulanda and Paya to access healthcare services. Bernard attributes this to the fact that the facility is always staffed and with higher chances of getting a medical prescription and drugs for treatment after diagnosis.
When it comes to general healthcare services, this pharmacy and lab could be one of the very few reliable ones in the District and probably the only one in this subcounty where one can receive prescribed medication at the facility after diagnosis. In many facilities drugs can be out of stock for months.
The Central Government also makes a significant contribution to the health facility in stocking drugs annually from the Primary Health Care Fund (PHC).
Annually the facility receives an estimated financial allocation of 10,000,000/- (approximately $2,800); The District also supplies this facility free vaccines and one government paid staff.
Poor quality of care is a critical barrier to women and children’s utilisation of health services in low and middle-income countries (LMICs). Waiting times, administrative inefficiency, weak or insensitive case management, drug stock-out, equipment shortages and poor condition of facilities have all been shown to restrict the intended benefits of universal health coverage. Quality considerations are as important as direct and indirect costs in determining health-seeking behaviour, yet still do not receive the same attention from health planners as service coverage and affordability. The beneficiaries of reproductive, maternal and child health services are often the most vulnerable. Women and children have the right to safe, effective, patient-centred health services that respect their needs, perspectives and dignity.