By Patrick Okino
At Apuce Health Centre II in Ayami Sub-county, Lira District, expectant mothers crowd a small waiting room, anxiously waiting for antenatal services. Among them is Christine Akello, who arrived at 8:00 a.m. for her first antenatal visit but had still not been attended to several hours later.
Her frustration reflects the reality facing many mothers at the rural health facility, where a single midwife is responsible for providing a wide range of maternal and child health services.
“I came early hoping to be attended to quickly, but I am still waiting,” Akello said, visibly exhausted. “I cannot blame the health worker because she is alone and has to serve all of us.”
On the day of her visit, more than 30 pregnant women were waiting for antenatal care.
Another expectant mother, Betty Apio, said she arrived at 9:20 a.m., submitted her antenatal book and was still waiting to be called.
“I have been here for hours without receiving any service,” she said.
Beatrice Abonyo, who brought her two-year-old child suffering from malaria-related symptoms, said the long waiting time was equally frustrating.
“I first tried treatment at a clinic but my child did not recover. I came here hoping to get better care, but the delay is too long,” she said.
Judith Ajwang, the facility’s only midwife, shoulders responsibilities that would ordinarily be shared among several health workers.
Besides registering patients, she records vital signs, including weight and blood pressure, performs abdominal examinations, conducts HIV and sickle cell tests, identifies high-risk pregnancies, refers mothers for ultrasound scans, provides nutrition counselling, offers family planning services, attends to postnatal mothers and assesses the nutritional status of children under five.
Ajwang, who was transferred from Ogur Health Centre IV in 2024, says she attends to between 28 and 35 pregnant women on a typical clinic day.
“My role is to examine mothers, conduct blood tests and identify high-risk pregnancies because if we fail to detect complications early, maternal deaths will remain hidden in the community,” she said.
She noted that the health facility is supposed to have two midwives and two nurses, yet she works alone.
“The mothers wait for long because I am the same person providing family planning services, postnatal care and antenatal services,” Ajwang explained. “I report for duty at 8:30 a.m. and sometimes leave at 6:00 p.m.”
“When you compare the workload assigned to one midwife, you feel like shedding tears,” she added.
Before Ajwang’s deployment in 2024, Apuce Health Centre II had operated without a qualified midwife since 2012.
The shortage forced expectant mothers to travel between eight and 10 kilometres to access antenatal services at Ogur, Aromo or Abala health facilities.
The facility in-charge, Lilly Epila, said she found the health centre without a midwife when she was posted there in June 2015.
“In 2022, we received a comprehensive enrolled nurse. Because she had midwifery skills, I trained and supported her to provide antenatal care due to overwhelming community complaints,” Epila said.
“People were unhappy because they had to travel long distances to Ogur, Aromo or Abala for antenatal services.”
However, after the nurse was transferred, the facility once again remained without anyone to provide antenatal care.
Epila said she repeatedly raised the matter with district authorities until Ajwang was transferred to the facility in 2024.
“She is a very committed midwife. She examines mothers, refers them for ultrasound scans, provides nutrition education and monitors the nutritional status of children under five,” Epila said.
Established in 2012, the health centre initially had a midwife employed by a non-governmental organisation, but her contract later ended.
For years afterwards, the facility relied on a nursing assistant who lacked the skills to provide antenatal care.
According to Epila, Apuce Health Centre II is expected to have nine staff members but currently operates with only six.
“We urgently need another midwife and at least two nurses to improve service delivery,” she said.
District grapples with shortage of midwives
Lira District Assistant District Health Officer in charge of Maternal and Child Health, Edmond Aceka, acknowledged that the shortage of midwives is affecting maternal health services across the district.
He said Lira District has only 33 midwives serving in 14 government health facilities.
“The staffing level for midwives is still very low and there is a huge gap that needs to be filled,” Aceka said.
He revealed that although government allocated Shs300 million to recruit health workers in the in financial year 2025/2026, the recruitment failed after the Ministry of Public Service did not grant clearance before the financial year ended.
“The money was eventually returned to the Consolidated Fund because the financial year expired before recruitment could be completed,” he explained.
Aceka said the district is preparing a fresh recruitment plan for the new financial year and will again seek clearance from the Ministry of Public Service to recruit more health workers, especially midwives.
“We also have some midwives who are chronically ill and unable to work, yet the number of mothers seeking antenatal services continues to increase,” he said.
He emphasized that midwives play a critical role in providing antenatal care, conducting deliveries, offering family planning services, admitting expectant mothers, managing nutrition programmes and supporting immunisation.
He said there is an enormous workload on the available midwives making recruitment of more staff is essential if they are to improve maternal health services and reduce preventable maternal deaths.