Home > All Stories > Paying a great deal for maternal health in Kapunga

Paying a great deal for maternal health in Kapunga

Yohana Saning'wa carrying his pregnant wife Mbuke Sena from her monthly clinic at Chimala.

By Daniel Mbega, Mbarali

AT a small, makeshift-bridge made of logs connecting Kapunga and Mbalino villages, in Mbarali district, Yohana Siling’wa (38) struggles with a bicycle carrying his pregnant wife, Mbuke Sena (32). They are coming back from Sena’s monthly clinic at Chimala Mission Hospital, 29km away from the couple’s home.

It’s a sunny afternoon and Siling’wa is sweating profusely. It is hard enough to ride a bicycle all the way from Mbalino to Chimala and back in this heat, but especially so when you are carrying someone in Sena’s condition.

The road is typically rough and very uneven and oftentimes, Siling’wa has to get off the bicycle and push it rather than cycle. A good Samaritan helps push them over the bridge and to the other side of the small stream that runs through the fields of rice.

“At least I have a month’s break before I have to take her back to the clinic again for delivery. The 58km ride every time she attends her clinic is a tiring. I think this could be the last pregnancy for my wife. It is hard. Four of my children were born at Chimala Mission Hospital. I have endured this every time my wife gets pregnant but now I think it’s enough,” he says.

But as hard as it is for Siling’wa, the bicycle rides to and from the mission hospital have been somewhat harder for his wife and for their family as a whole. Though the couple has six children, this is their tenth pregnancy. Sena has had two miscarriages and last year, the couple lost their five year old daughter to a severe case of malaria.

Sena remembers being told by the doctor at Chimala Mission Hospital that it was quite likely because of the bumpy bicycle rides to and from hospital that she had the two miscarriages. But Sena says they don’t have the money to pay for a bus from Kapunga to Chimala and back as that would cost Shs. 8,000 for the two of them. So though it was risky, they opted to take a bicycle.

“Back then the road was even rougher. If we had a dispensary at Kapunga it would be easy for me to walk their and attend my clinics,” she says.


Mbuke Sena

Located in Chimala along the Dar es Salaam – Mbeya highway, the Mission Hospital, which was started in 1962 by missionaries of the New York Arena Church of Christ, provides services to more than 25,000 people, according to staff at the centre. It is 30km away from the Mbarali District Hospital in Rujewa.

It is a great deal to be pregnant in Kapunga

Because they live so far away, the medical assistant at the mission hospital instructed them to go back to Chimala and rent a room there three weeks prior to Sena’s due date.

The centre provides decent housing for Shs. 500 per person, per night, but even this is too much for most Kapunga residents, who depend on agriculture for a living.

“That does not include food and other things. And, I have to take someone who will look after me. I also have to pay not less than Shs. 35,000 at the hospital as charges for delivery. It’s a great deal to be pregnant in our villages as maternal health services are unavailable,” says Sena.

It is a great deal to fall sick if you live in Kapunga village. Most villagers depend on Chimala Mission Hospital for health care, as there is no dispensary nearby.

Chimala Mission Hospital entrance.

The Chimala Mission Hospital

The Labour Ward

The hospital morgue

“The dispensary that served Kapunga and neighbouring villages was situated on the Kapunga Rice Project Limited premises but the investor who bought the farm had that closed down long ago. Now, even when you have malaria you need to go to Chimala,” says Sena.

When Export and Trading Company Limited took over ownership of the Kapunga Rice Project in 2006, it closed down the public dispensary which was on the farm’s property.

The former dispensary at Kapunga ex-NAFCO area.

“People walk more than 25km to seek health care and it is too much, particularly for women, children and the aged,” says Kapunga village chair, Ramadhan Nyoni.

During the rainy season, the usual road to Chimala is impassable. The alternative route is 40km long.

“Malaria cases are rampant in the rainy season. The government’s non-provision of essential services for pregnant women is a violation of the right to life.”

Childbirth continues to be dangerous for both mother and child in Tanzania and the country has recorded a dismal performance in reducing maternal mortality compared to children deaths, hence making it difficult to meet target number five of the millennium development goals (MDG’s)

When addressing a two-day meeting of the Commission on Information Accountability for Women and Children’s Health, in Dar es Salaam on May this year, President Jakaya Kikwete said the the number of maternal deaths has declined from 578 to 454 for every 100,000 live births as opposed to that of children which has dropped to 81 from 162 live births, making the country one of 49 nations in Africa that account for ninety eight per cent of women and children deaths in the world.

“You can all see the magnitude of the problem, we have made little progress, but honestly we still have a long way to go,” President Kikwete was quoted as saying. “In the children’s mortality, I think we can reach the target by 2015, but I’m still sceptical for the case of women, due to the slow pace we are moving with.”

Women face many challenges during pregnancy and delivery, among them being inadequate health care, lack of faith in biomedicine, support from men and lack of access to hospitals, leading some of them to deliver at home.

“Many women in the village deliver at home because of lack of nearby health care facilities. To get to Chimala mission hospital one would have to hire a car for Shs. 40,000, use a bicycle like Sena or get on the bus,” says Mwanahamisi Ally (52) a mother of four and resident of Kapunga.

Bernard Kulanga, the Chimala Mission Hospital’s Chief Executive Officer, says though there are some dispensaries in the small town, theirs is the main dependable health centre especially for maternal health.

“We receive many patients regularly, even those suffering from malaria. People come here because of the services we provide, and as a missionary centre run by the Church of Christ, we are here to serve people, especially women and children who form the largest number of our clients here,” he says.

Bernard Kulanga, the CEO at Chimala Mission Hospital

Kulanga says, the hospital, which receives referral cases from the Mbarali District Hospital, has 103 staff – 5 Medical Officers, two Assistant Medical Officers, four Clinical Officers, 30 Nurses and other staff, though the demand is high.

He says they receive an average of 90 patients daily including in-patients and out-patients. Most are cases of severe malaria and diarrhea for children.

“Because all of our staff have to be paid, we charge enough to generate an income. For delivery, we charge not less than Shs. 35,000 for normal delivery and Shs. 150,000 for caesarian. This amount covers all services plus medicines,” he says.

According to the hospital CEO, patients are admitted and availed of all services without payments, thus enabling everyone to receive health services on time.

“We don’t charge before providing treatment, that isn’t how we function. We believe that a patient needs treatment and payments come after that. For those who don’t have money we discharge them and ask them to come and pay after they have managed to get money. But most of them disappear, and we can’t go out there to search for them,” he adds.

The National Health Policy of 1990 is aimed at improving the health status of all people wherever they are, in urban and rural areas, by reducing morbidity and mortality and raising life expectancy because physical, mental and social well being is a major resource for economic development.

Specifically, the policy is aimed at reducing infant and maternal morbidity and mortality and increasing life expectancy through the provision of adequate and equitable maternal and child health services, promotion of adequate nutrition, control of communicable diseases and treatment of common conditions.

George Kagomba, the Mbarali District Council Director, admits that the Kapunga area and the nearby villages are yet to see “significant improvement” in delivery of health services.

He says the closure of the public dispensary at the ex-NAFCO farm is one of the challenges in the health sector.

“The government’s vision is to see that every village has a health centre and the suffering of those people (from Kapunga) is of much concern,” he says.



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