Uganda: C-Section Births - Government Accuses Hospitals of Greed

14 October 2019

The Ministry of Health has decried the rise in the number of caesarean section births, saying they are driven by the hospitals' desire to make more money compared to normal deliveries.

Ms Sarah Opendi, the State Minister of Health for General Duties, said unlike in the past when doctors used to prepare mothers to deliver normally, it is no longer the case.

"They are doing it [C-sections] for money. Can we know why they [C-sections] are there and previously they were not? And since government has constructed lower facilities in most of the areas, why are the C-sections rampant?" Ms Opendi asked in an interview last week.

According to World Health Organisation, maternal mortality and morbidity is approximately five times greater with caesarean than with vaginal birth.

In Uganda, the trend of average C-section rate in the general hospitals has been increasing over the years. For instance, the cases increased to 29 per cent in 2018/19 from 28 percent in 2017/18, according to the latest health sector review report released recently.

Ms Opendi said the vice is also prevalent in government hospitals where health workers extort money from mothers even when the procedure is supposed to be free of charge.

She said there is need for a discussion with the obstetrics and gynaecology association about the matter.

"That one has been a money making venture but since government has increased the salaries [of doctors in public service] they should do this in a more professional way," Ms Opendi added.

She also condemned young mothers who are misled to go for C-section because they don't want to "push and enlarge their private parts."

According to the 2018/19 sector review report, Nakasero Hospital in Kampala had the highest C-section rate of 72 per cent (586 C/S out of 747 deliveries), followed by Ngora NGO at 61 per cent. Other hospitals are Paragon in Kampala (535 C-sections out of 955 deliveries), Villa Maria Hospital (625 C-sections out of 1,097 deliveries and St Joseph Kitovu (305 C-sections out of 625 deliveries).

When contacted, Mr Julius Mugisha, the Nakasero Hospital spokesperson, denied that they deliberately conduct C-sections to earn more money from patients. He attributed the cases to the category of healthcare the hospital offers.

"We are a consultant-based hospital and receive patients that sometimes have complications. The most important thing is a bouncing baby," Mr Mugisha said.

An administrator at Paragon Hospital, who preferred anonymity, said they conduct C-section as a timely intervention to avert maternal death.

"If you are going to look at C-section rate and death rate, you can't compare us with the lower health centres," the administrator said.

Sr Stella Nabugwawo, the hospital administrator of Villa Maria Hospital in Masaka District, attributed the rates to the fact that the health facility is a referral.

"It is the only hospital where the lower health centres refer patients to. If you see how we charge ceasarean sections at only Shs300,000 it cannot be because of money," she said.

Dr Alfred Lumala, the medical director of Kitovu Hospital, said the high C-sections imply that the health systems are efficient.

"We charge Shs400,000 for C-section and if we could, we would avoid C-section because we put in a lot of money than what we charge the mothers," he said.

Costs

Out of the 22 hospitals which carried out the highest number of C- sections in the country, only Nyapea Hospital in Zombo District, is government-owned. The rest are private or faith-based hospitals. The cost of C-section in private hospitals ranges between Shs2.5m and Shs3m compared to Shs800,000-Shs1m for a normal delivery.

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