In the Busoga region of eastern Uganda, the fight for survival has long been a daunting challenge for mothers and their children. With one of the highest institutional maternal mortality rates in the country – 93 deaths per 100,000 institutional deliveries compared to a national average of 82.7 (Ministry of Health Annual Health Sector Performance Report 2023/2024)– the urgency to act is undeniable. For years, families have grappled with a broken emergency referral system, where the lack of resources and infrastructure has turned preventable complications into tragedies.

Infant mortality in Busoga stands at 4 per 1,000 live births, exceeding the national rate of 36, while under-five mortality is 65 per 1,000 compared to the national 52. Neonatal mortality in Busoga is 28 deaths per 1,000 live births compared to a national rate of 22.  These grim statistics, highlighted in the 2022 Uganda Demographic and Health Survey, underscore a health crisis that disproportionately affects the region's most vulnerable.

At the heart of the problem lies the inability of many lower-level health facilities to manage critical cases. Without an efficient referral system, families in Busoga have resorted to unsafe and costly means of transportation – motorcycles or private vehicles – to seek emergency care. For many, the cost is too high, and the delays are fatal.

Determined to rewrite this narrative, the World Health Organization (WHO), in partnership with the Korea International Cooperation Agency (KOICA), and in collaboration with Uganda’s Ministry of Health, took decisive action. Through a transformative project, the Busoga region received seven ambulances strategically deployed to key health facilities. For the first time, these facilities gained access to dedicated emergency transport, bringing hope and life-saving care to communities that had been overlooked for too long.

For Juliet, a 26-year-old expectant mother from Kamuli, the impact was immediate and profound. “When my labor began, I was in so much pain. The clinic told me I needed to go to the hospital immediately, but in the past, we would have had to hire a motorcycle – dangerous and slow. This time, the ambulance came quickly. It took me to the hospital safely. My baby and I are alive because of it,” she said, her voice filled with gratitude.

But the initiative didn’t stop at ambulances. WHO ensured sustainability by establishing five ambulance management committees, comprising 55 community members, to oversee operations, maintain accountability, and ensure the long-term success of the program. Routine maintenance is managed by the Regional Ambulance Coordination Cell at Jinja Regional Referral Hospital, while Uganda’s Ministry of Health Emergency Medical Services (EMS) department supplies fuel to keep the fleet operational 24/7.

Dr Charles Njuguna, WHO Representative in Uganda, emphasized the importance of this intervention. “Our support has been vital in reducing maternal and child mortality in the Busoga region, ensuring that these lives are prioritized and safeguarded.”
 

For Sarah, an emergency nurse at Iganga Hospital, the transformation is palpable. “Before, we lost so many patients because they couldn’t reach us in time. Now, when the ambulance phone rings, we know help is on the way. It gives us hope and energy to do our best,” she said.

Since their deployment, the ambulances have transported more than 4,500 patients to higher-level care. Approximately half of these were pregnant women, while 15% were children under five. Each journey is a testament to the power of strategic partnerships and targeted investments in healthcare systems.

As Juliet reflects on her experience, her words echo the collective sentiment of the community: “It’s not just an ambulance – it’s a second chance at life.”