By KT Reporter
In the dimly lit maternity ward of Pajule Health Centre IV in Pader — a district without a single hospital — one metal bed carries the burden of an entire community. Every day, women crowd the narrow space; some lie on thin plastic sheets while others crouch on the floor, waiting for their turn to deliver. Here, hope and pain constantly collide.
For Grace, a mother of three from Lapul St. Mary in Bongtiko Sub-county, the memory of her last pregnancy remains haunting. “I begged for help, but she ordered me to leave,” Grace recalls softly, her voice trembling as she remembers that February night in 2025 when she lost her unborn child after being chased out of the maternity ward while in labor. “I felt helpless. I just wanted a safe place to give birth.”
“At the government facility, expectant mothers are really suffering. I went to deliver at the maternity ward, but the midwives handle mothers recklessly. I was pulled out of bed when I was almost delivering and ended up giving birth outside.”
Grace’s story mirrors that of many women who seek maternity services from Pajule Health Centre IV with fear rather than hope. Locals now call it a “torture chamber” — a place where mothers endure neglect, overcrowding, and verbal abuse. Yet for most, it remains the only accessible health facility offering delivery services within miles.
A Ward Beyond Capacity
Pajule Health Centre IV handles an average of 12 deliveries a day, translating to over 1,500 births annually, all on a single functional delivery bed. The facility also attends to about 170 outpatients daily, stretching its staff and infrastructure far beyond capacity. Inside the ward, privacy is a forgotten concept. Mothers groan side by side as nurses hurry between them, improvising where equipment is missing. The same space used for inpatients doubles as a maternity ward. After each birth, attendants rush to wipe the blood-stained bed for the next woman in line. Tito Okello Brilliant, the Pajule Town Council Chairperson III, admits that the maternity section can no longer cope with the growing population. “The limited space creates chaos. Some mothers deliver on benches or the floor while waiting for the bed to be cleaned. We are grateful to the staff for trying, but this is not humane,” he says.
Women on the Edge
For many expectant mothers, giving birth in health facilities across Pader District — including Pajule Health Centre IV — feels like gambling with life. Ketty Ayaa, a 22-year-old first-time mother from Lagile Parish in Awere Sub-county, recalls delivering on a plastic sheet beside another woman also in labor.
“I was scared. There was no bed, and the midwife was shouting at us to be quiet,” she recounts. “The midwife beat me up and pushed me away.” Many women now say they prefer to deliver at home after enduring or witnessing verbal and physical abuse in health centers. “I would rather risk at home than be insulted while in pain,” Ayaa adds. Health officials acknowledge that such experiences have discouraged antenatal attendance and led to increased unsafe home deliveries in surrounding sub-counties.
Overwhelmed but Trying
Dr. Denis Ocaya, the in-charge of Pajule Health Centre IV, acknowledges the complaints and regrets the suffering mothers face. “We are aware of the challenges,” he says. “Our staff are doing their best under extremely difficult conditions. Patients deserve respect and safe care, and we are working to restore dignity in our maternity services.”
Despite the challenges, the facility continues to record high delivery numbers. Between May 2021 and May 2022, Pajule registered 1,514 births, accounting for 59.3% of all deliveries in Pader District. However, maternal and neonatal mortality rates remain alarming — perinatal mortality stands at 11%, neonatal mortality at 5%, and the cesarean section rate at just 3.3%, far below national standards for emergency obstetric care.
Dr. Benson Oyoo, the Acting District Health Officer, praised the staff’s commitment but warned that neglect could erase years of progress. “We are improvising with what we have, but it’s simply not enough. The government must support us to meet standards under the National Health Policy II and the National Minimum Health Care Package,” he emphasized. “Pajule Health Centre IV should be upgraded to a district hospital to cater for the overwhelming population, and two more Health Centre IVs should be established in Aruu County and Aruu North County.”
Systemic Failures Behind the Crisis
The shortage of beds is just a symptom of deeper structural failures. According to district records, only 28% of the required health workforce is in place to serve a population of over 240,000. Six sub-counties still lack Health Centre III facilities, and two have none at all — a violation of the National Health Policy II standards. The Acting DHO also noted that poor road infrastructure hinders movement of expectant mothers seeking care. District leaders are now calling for an upgrade of Pajule Health Centre IV to a district hospital, a project estimated to cost between Shs 5 billion and Shs 20 billion — funds the Ministry of Health says are currently unavailable.
Col. (Rtd) Fearless Obwoya Oyat, the Pader District LCV Chairperson, says the upgrade is long overdue. “Every day, mothers deliver in pain and fear. We urgently need more delivery beds, trained midwives, and expanded space. These are not luxuries — they are rights,” he insists.
Policy and Promises
Uganda’s National Health Policy II (2010) mandates that every Health Centre IV provide Comprehensive Emergency Obstetric and Newborn Care (CEmONC) — equipped with delivery beds, a functional theater, and qualified personnel. The National Minimum Health Care Package (NMHCP) also prioritizes maternal and newborn health as a key intervention area. Justine Ocen, the Pader District Vice Chairperson and Secretary for Health, confirms that the district has formally requested the Ministry of Health to upgrade Pajule Health Centre IV to hospital status. “We have submitted all documentation and hope the Ministry considers our case soon,” he says, warning health workers accused of mistreating expectant mothers. “We’ve heard complaints from mothers. Once they report mistreatment, we shall take disciplinary action.”
In response, Dr. Jane Ruth Aceng, Uganda’s Minister of Health, reiterated the government’s commitment to ensuring every district has at least one hospital. She acknowledged the shortage of infrastructure and personnel in rural areas and said interim support will be provided through facilities like Acholibur Health Centre III to handle overflow deliveries.
The Human Cost
Behind every statistic lies the story of women enduring humiliation, pain, and loss in places meant to save lives. “We want safe, dignified childbirth, not fear and overcrowding,” Grace pleads. As the cries of newborns echo through the crowded ward, the single delivery bed stands as both a symbol of resilience and neglect — bearing witness to thousands of births and the silent suffering of mothers who risk everything to give life. Until policies on paper translate into beds, staff, and dignity on the ground, mothers in Pajule and beyond will continue to deliver between hope and heartbreak — a situation that has already driven many back to Traditional Birth Attendants (TBAs) out of desperation.
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