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First Delay affecting service delivery at Nakapiripirit HCIII.

Photo by Edward Akaki: Awas attending to a client

Nakapiripirit HCIII, which covers 11 villages and 5 parishes, including Nakapiripirit Town Council, registers over 50 patients daily.

Whereas this figure seems big, it could have even been much more had the surrounding community sought health care in time.

According to the Health Center in charge, assistant nursing officer, Hellen Ameny, most patients report to the health facility when their conditions are much worse due to “First Delays” as such people deliberately take time to report to a health facility.

She says this is the reason the facility keeps referring such cases to Tokora HCIV, yet they could be helped if they reported earlier.

Ameny states that although women do seek for medical services quite often, their male counterparts tend to do the same when it’s almost too late to assist at the facility level.

But according to Michael Lomongin from Katanga village in Nakapiripirit, most roads in the district are poorly graded and affect transportation of patients to health facilities, especially during rainy seasons.

He said Village Health Teams should be provided with transport means so that they can be able to traverse their villages to educate but also provide first aid to the elderly who may not be able to walk to the nearest facilities.

Celementina Angella, enrolled midwife at the facility, said this has even become worse with the farming season as most patients, especially pregnant mothers first go to their gardens and then later go to the health facility.

However, the area woman Member of Parliament and also the Minister of State for Disaster Hon. Esther Anyakun said those who deliberately delay seeking medical services, yet each sub county in the district has a medical facility, are to blame.

Anyakun said she and other development partners in the district like UNICEF have provided women with birth aids (mama Kits) and nutrition supplements, which have since attracted a big number of mothers to give birth at the health facilities.

According to, Maternity Worldwide uses an integrated approach to address each of the issues women face when trying to access safe childbirth. This is based on the Three Delays Model, which identifies three groups of factors which may stop women and girls accessing the maternal health care.

The “Three Delays” model proposes that pregnancy-related mortality is overwhelmingly due to delays in: (1) deciding to seek appropriate medical help for an obstetric emergency; (2) reaching an appropriate obstetric facility; and (3) receiving adequate care when a facility is reached.

The Three Delays Model is a practical framework that can be useful for understanding barriers to emergency care and developing more tailored interventions. In rural Karamoja Region, training community members and healthcare providers to recognize symptoms and manage acute conditions can reduce delays in care seeking and receiving adequate care at health facilities.

While better infrastructure and resources are necessary, improvements in emergency care delivery in this setting may be achieved through modest, yet targeted behavioural change interventions, such as training of community members and healthcare providers.

As much as the delay is affecting service response, the in facility in charge states that they have never registered any maternal related death since the year begun. This implies that despite the delays, the health workers are doing extra tasks to ensure patient’s satisfaction.

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