The causes of most maternal deaths include severe bleeding before and after delivery, infections, unsafe abortion, hypertensive disorder (eclampsia) and obstructed labour

With just four years away to 2015, Uganda is unlikely to attain the targets for Millennium Development Goals 4 or 5 (MDG 4 or 5).  The period when most mothers and newborn are at the greatest risk of dying is at the time of delivery and immediately after delivery.

Most deaths are preventable, and are influenced by a complex interaction of social-economic, cultural, physical environment, health seeking behaviours and quality of health delivery services.

Maternal death is a notifiable condition since 2008. All maternal deaths should have a mandatory confidential review or audit.

The audits  are conducted professionally and provide opportunity to identify correctable factors to improve care including the procedures used for diagnosis, treatment, rational use of resources at health facility level; the resulting outcome and access gaps at a personal, family, community, or health facility that may have contributed to the death.

Recommendations on quality improvements are made so that the next mother or newborn does not die under similar circumstances.

In many instance, audits done at health facilities have found multiple health system failures like lack of essential supplies for basic or comprehensive emergency obstetric care, lack of blood, an essential component; especially when dealing with bleeding problems, human resource deficiencies with large ratio of patient to one health workers, lack of theatre space to perform timely appropriate lifesaving interventions and poor care by health providers.

A maternal or newborn death is a tragic event that leaves a scar on the family, the community, the health workers and the country at large.

Professionalism is a core value that we promote and each health worker is guided by the ethical principles of medicine namely: Beneficence, respect, do no harm, and justice. Misconduct or negligence is severely frowned upon by the profession and should be dealt with by the relevant bodies if a health worker is found liable.

Inquiry into a maternal or newborn death is, as a standard, supposed to be confidential, follow certain principles that include anonymity and respect to both the aggrieved and the health workers and cover the whole spectrum of possible causes spanning from community to health facility.

In the recent past, this process has become rancorous, causing confusion, and demoralising to many of health workers who spend hours caring for the sick in conditions of poor infrastructure, deficiencies in supplies and poor pay.

Failure to address the major root causes of maternal death of a frail health delivery system and lapping all the blame of health workers oblivious of the other possible causes of deaths in the community in many instances is retrogressive and affects the gains achieved in improving the care of the mothers and their newborns.

If more  political advocacy and commitment is amplified , increase in  financing  the health sector, a multi-sectoral approach to the problem, community education, spacing, use of family planning,  improving  quality of care at each stage of pregnancy and increasing the demands of the population then we are likely to see real change.