In the dimly lit maternity ward of Pajule Health Centre IV in Pader District — a district without a single hospital — one metal bed carries the burden of an entire community. Every day, women crowd into the narrow room; some lie on thin plastic sheets, 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 the 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.”
Grace’s experience mirrors that of many women who approach 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 facility offering delivery services for miles.
The health centre handles an average of 12 deliveries a day, translating to over 1,500 births a year, all on a single functional delivery bed. It also attends to about 170 outpatients daily, stretching its staff and infrastructure far beyond capacity. Privacy is non-existent; mothers groan side by side as midwives rush between them, improvising where equipment is missing. After each birth, attendants quickly wipe down the blood-stained bed for the next woman in line.
Tito Okello Brilliant, Chairperson of Pajule Town Council III, admits the facility 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,” he says. “We are grateful to the staff for trying, but this is not humane.”
Women on the Edge
For many expectant mothers across Pader District, giving birth in a health facility feels like gambling with life.
Ketty Ayaa, a 22-year-old first-time mother from Lagile Parish, Awere Sub-county, recalls delivering on a plastic sheet beside another woman 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 and pushed me away.”
Such experiences have driven many women to deliver at home or seek help from Traditional Birth Attendants (TBAs)despite the risks. “I would rather risk at home than be insulted while in pain,” Ayaa adds.
Health officials acknowledge that abuse and overcrowding have discouraged antenatal visits and increased unsafe home deliveries in surrounding sub-counties.
Overwhelmed but Trying
Dr. Denis Ocaya, the officer in charge of Pajule Health Centre IV, admits the system is overstretched.
“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 constraints, Pajule continues to record the highest number of deliveries in the district — 1,514 births between May 2021 and May 2022, accounting for 59.3% of all deliveries in Pader. Yet maternal and neonatal outcomes remain worrying: perinatal mortality stands at 11%, neonatal mortality at 5%, and the cesarean section rate is just 3.3%, far below national standards for emergency obstetric care.
Dr. Benson Oyoo, Acting District Health Officer, praises the dedication of health workers but warns that without support, progress could be reversed.
“We are improvising with what we have, but it’s simply not enough,” he says. “The government must help us meet the standards set under the National Health Policy II and the National Minimum Health Care Package. Pajule Health Centre IV should be upgraded to a district hospital to serve the growing population.”
Systemic Gaps
The shortage of delivery beds is only one symptom of a deeper crisis. District records show that only 28% of the required health workforce is in place to serve a population exceeding 240,000. Six sub-counties lack a Health Centre III, and two have no health facility at all — a violation of national policy.
Poor road infrastructure further complicates access to care, often delaying mothers in labor from reaching facilities. Upgrading Pajule Health Centre IV to a hospital — estimated to cost Shs 5–20 billion — has been proposed, but the Ministry of Health says funds are currently unavailable.
Col. (Rtd) Fearless Obwoya Oyat, the Pader District LCV Chairperson, insists the upgrade is overdue.
“Every day, mothers deliver in pain and fear,” he says. “We urgently need more delivery beds, trained midwives, and expanded space. These are not luxuries — they are rights.”
Policy and Promises
Under Uganda’s National Health Policy II (2010), every Health Centre IV is mandated to provide Comprehensive Emergency Obstetric and Newborn Care (CEmONC) — including delivery beds, a functional theater, and qualified personnel. The National Minimum Health Care Package (NMHCP) prioritizes maternal and newborn health as a key intervention area.
Justine Ocen, the Pader District Vice Chairperson and Secretary for Health, says the district has formally requested the Ministry of Health to upgrade Pajule Health Centre IV.
“We’ve submitted all documentation and hope the Ministry considers our case soon,” he says. He also warns health workers against mistreating mothers: “Once reports are verified, disciplinary action will be taken.”
Dr. Jane Ruth Aceng, Uganda’s Minister of Health, reaffirmed 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 Acholibur Health Centre III to handle overflow deliveries.
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, Pajule’s lone 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 Pader and beyond will continue to deliver between hope and heartbreak.
