Ask a resident on Serinyabi or Kaaza islands when they last went to a health center and you may be surprised.
The fishing communities that reside on these islands are separated from the nearest health facility by an hour long boat ride. The cost and unreliability of public boat transportation make accessing a health facility unrealistic for many islanders. Residents are left to rely on under-trained Village Health Teams (VHTs), infrequent outreach services, or may go without any care at all. Limited healthcare access combined with prevailing social determinants have led these fishing communities to suffer from some of the poorest health indices in the country.
GHC Fellows Bring Services to Fishing Communities with the Article 25 Global Day of Action
In recognition of the Article 25 Global Day of Action, GHC fellows joined Uganda Development and Health Associates (UDHA) and the fishing communities on Kaaza and Serinyabi islands to provide increased access to health services and preventative treatments.
UDHA is a grassroots organization in eastern Uganda that provides health outreach and basic services to the Iganga and Mayuge Districts, including the fishing communities in Mayuge District as part of its Maternal and Child Health Rights Promotion project. I am spending my fellowship year at UDHA, as the Advocacy and Communications Manager. Helping to shape a new advocacy program within the organization has allowed me to be more creative in the projects that we undertake, including planning the Global Day of Action.
On October 25, during the Global Day of Action, UDHA provided a range of services that islanders are often either forced to go without or only have access to on an infrequent basis. These services included HIV testing and counseling along with distribution of condoms, family planning methods, antiretroviral drugs, and children’s vitamin supplements. During the Global Day of Action, the group was able to test and counsel 346 individuals for HIV, while also providing 40 individuals with ARVs, 32 women with family planning methods, and 231 children with Vitamin A supplements.
Fishing Communities: Most-At-Risk and Left Without Services
By law, all Ugandans should have reliable, free access to the services provided during the Global Day of Action by visiting any government-run health center. For rural communities such as the fishing islands, this is complicated by their low socio-economic status and the distance to the nearest health center. Uptake of these services is vital in order to address Uganda’s poor health indices: HIV prevalence rates are once again on the rise and reductions in infant and maternal mortality rates have slowed.
Nowhere is the situation worse than among fishing communities. Fisher folk are the fastest growing of the Most-At-Risk Populations (MARPs), with an HIV prevalence rate 3 times higher than the national average. These communities also have an above-average fertility rate and correspondingly high maternal mortality rate.
In addressing these prevailing poor health outcomes, the Government of Uganda has emphasized the impact of social determinants, especially the lack of quality health education and awareness. In reaction, the few efforts provided to this population have focused on sensitizing the communities about the importance of different services and behaviors. This approach has successfully increased the demand for healthcare services. However, the demand has not been adequately met by an available supply of healthcare services or facilities for the island populations. Advocating on the importance of preventative healthcare services without providing access to them is an injustice to the communities targeted by these very messages.
Three of the six major islands in Mayuge district do not have a health facility or immediate access to trained health professionals. The burden created by travel distance and cost prevent many islanders from reaching a health facility on the mainland and keep medical services out-of-reach.
The Government of Uganda has failed to recognize the importance an accessible healthcare system plays in affecting social determinants and connecting island communities with their intrinsic health rights. Failure to provide adequate investment and equitable access to quality health services and facilities among fishing communities will prevent the country from realizing targeted health goals in the future.
Fishing Communities Call for a Change
Plans for the Article 25 Day of Action were birthed from a conversation with a man named Owori Joseph, a Council Chairman and VHT on Serinyabi Island. I was interviewing Joseph to gather a qualitative measurement of the impact that UDHA’s project was having on islanders’ awareness and willingness to take up various preventative healthcare services. Joseph assured me of his community’s appreciation of the project, but reminded me about his community’s inability to access these services without a health center. The community had repeatedly been promised that the government was planning to provide a health facility for the island. “But it has not happened, due to A, B, C… we don’t exactly [know],” Joseph told me.
Until a health center does arrive, Joseph assures me that the health on his island will continue to be defined by the terrorizing idea that “no money means no life”. Joseph figures that 40% of the deaths on his island result from preventable complications, primarily resulting from a lack of access to appropriate services.
Support Comes from the Global Health Community
UDHA and GHC fellows brought fresh energy, renewed commitment, and global attention to the islanders’ struggle for a health center. The group balanced the provision of direct service deliverables with advocacy initiatives. This approach was based on the understanding that preventative healthcare and treatment do not provide reliable solutions without frequent follow-up and consistent access. Therefore, the two groups worked together to mobilize the communities, assisting them in collecting 1,612 petition signatures and providing the means for the community to address four Mayuge District Local Government Officials in a public forum. All actions were based around the demand for construction of a basic health center on each island.
The government officials involved were generally supportive of the effort and appreciated the opportunity to interact directly with their constituents. Impressed by the communities’ well organized efforts, the officials are now interested in partnering with the residents to lobby the central government and Ministry of Health for additional funding to sustain existing and create new regional health centers. The events were also covered by a national news channel and received online exposure from Article 25.
This event served as an example of the positive change that can be made through collective action. Uniting UDHA, GHC, the island communities, and government officials all with the aim of promoting awareness and justice, will help to win the fight to bring the right to health to the fisher folk of the Mayuge District, Uganda.