Inside the second busiest hospital in Uganda, a Somali refugee gingerly paces up and down the maternity ward to ease her labour pains, passing a Congolese woman resting in bed after a Caesarean section.
“I am happy because they welcomed me here. They help everyone, even if you are a refugee,” said Esther Kabumo from Democratic Republic of Congo. “If you don’t have money, it’s not a problem.”
On a continent known for poor healthcare and high infant mortality rates, the Ugandan capital is an exception.
Child deaths in Kampala fell faster than in any other African city between 2006 and 2011 – despite a large influx of refugees from war-torn neighbouring states, Save the Children said in a report on Tuesday.
In the five years to 2011, child mortality in the East African country fell to 65 deaths per 1,000 live births from 94 deaths per 1,000 live births.
Uganda has cut child mortality by 4.3 percent a year between 1990 and 2013, just below the 4.4 percent annual reduction needed to achieve a Millennium Development Goal on lowering the number of deaths of under-fives.
Its neighbours Rwanda and Tanzania are among 12 African nations on track to meet the goal, according to the U.N. children’s agency, UNICEF.
“Kampala is actually a success story,” said Carolyn Miles, chief executive of Save the Children USA, which focuses on urban health in its 2015 State of the World’s Mothers report.
Kisenyi health centre in Kampala, which delivers 600 babies a month, symbolises the shift in Uganda which has seen the country invest more money in the healthcare system to make it accessible for the poorest, Save the Children said.
Educating women about the importance of seeking medical care while pregnant, in labour and for newborns, has also helped save the lives of mothers and infants, the charity said.
Healthcare has been free in Uganda since 2001. Notices stuck on Kisenyi’s walls give patients several numbers to call if staff ask them to pay for services.
“It can be very dangerous for a mother when there is no money and you have to pay bills,” said Tracy Neema Twinomugisa, 27, whose three-day-old son was diagnosed with jaundice and taken to the neonatal unit.
She watched her baby sleep with a mask to protect his eyes from the incubator’s ultraviolet light. “If there is no money, you can die.”
Government outreach efforts that encourage people to seek health services via churches, mosques, the radio and door-to-door visits by health workers, have also underpinned Uganda’s success.
There has been a surge in women delivering in health facilities, which is crucial for mother and child survival, up from 41 to 57 percent between 2006 and 2011.
“A lot of it is about access and about people feeling that they are welcome to take part in those services,” said Miles.
In a busy bus park in downtown Kampala, health workers used a megaphone to urge people to come for free HIV testing.
“Many people don’t have time to seek health services so we are trying to pull the services nearer to the people,” said Doreen Bakeiha, a counsellor demonstrating how to use a condom amid raucous laughter.
Women who queued to have their fingers pricked so their blood could be tested were encouraged to visit a nearby clinic for family planning, antenatal and immunisation services.
Save the Children said under five mortality among Uganda’s urban poor fell by 29 percent between 1995 and 2006, compared to a two percent drop among rich urban children.
As a result, Uganda’s poorest urban children are now only twice as likely to die as the richest ones, compared to three times as likely in 1995.
But elsewhere the gap between the urban rich and poor is a cause for concern.
Today, 54 percent of the world lives in urban areas, and this is predicted to reach 66 percent by 2050.
While statistics generally show that people living in cities are healthier than those in rural areas, the data masks huge gaps between the rich and the poor.
“In 60 percent of the developing countries that we surveyed, city children living in poverty are actually more likely to die than those in rural areas,” said Miles.
The poorest under-fives living in urban areas are twice as likely to die as the richest, Save the Children’s research in 50 cities found. In Cambodia and Rwanda, this gap is almost fivefold.
Malnourished young children living in dirty, overcrowded slums often fall prey to diarrhoea, pneumonia and malaria, which can be fatal without the right treatment.
While under five mortality has almost halved globally since 1990, from 90 deaths per 1,000 live births to 46 deaths per 1,000 live births, the focus must now shift explicitly to the urban poor, Miles said.
“If we are going to end child preventable deaths, we have to look for the most deprived,” she said.
– Reporting by Katy Migiro; Editing by Katie Nguyen