The caseload for a midwife in the Kotido district of Karamoja, tucked in a remote part of north-eastern Uganda, strains belief: with just 18 midwives serving 9,600 mothers, according to district health officials, each midwife cares for at least 533 mothers a year. That’s more than triple the number recommended by the WHO (1 midwife/175 mothers a year).
As a result, midwives are overloaded, says Phillip Oringa, MD, the Kotido District Health Officer (DHO), “which affects the quality of services provided.”
But the heavy caseload is not the only issue confronting midwives. They face a complex array of problems, I learned during a visit earlier this month to examine the state of health and midwifery in Kotido and the Karamoja sub-region.
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