UNITED NATIONS — As world leaders gathered this week in New York for the UN Millennium Development Goal Review Summit, improving maternal health was high on the agenda. The Summit comes a week after new UN data was released showing that maternal mortality has declined by over 30 per cent since 1990, bolstering hope though that the rate of progress over the next few years can be accelerated. Much of that hope comes from those countries, that despite great obstacles and limited resources, have made impressive progress towards MDG 5.
This was the focus of a side-panel event, ‘Accelerating progress in achieving MDG 5: Trends and lessons from countries’, that brought together leaders of UN Development agencies and health officials from four countries that have made impressive progress in improving aspects of maternal health – Benin, Botswana, Ethiopia and Nepal. “The best way to make progress is to look at what is working in countries and build on that success,” said Dr. Margaret Chan, Director General of the World Health Organization.
Establishing effective policies and programmes in Nepal
Nepal, which began tackling the issue of maternal health when the country adopted a national health policy in 1991, has reduced its maternal mortality rate by over 50 per cent, though it remains high – 380 maternal deaths for every 100,000 live births. According to Dr. Sudha Sharma, Secretary of Health from Nepal, key to the countries success thus far has been excellent policies and plans, effective leadership, a motivated and dedicated health work force and community participation. Specific policies that expand access to emergency obstetric care, address skilled birth attendance, offer free maternity car and provide financial incentives for women seeking antenatal suppor have all been critical to success. Other factors have contributed as well, including support for transport to health facilities, and the legalization of abortion, which has reduced the number of women dying from unsafe procedures. Dr. Sharma also emphasized that educating mothers has been critical to the country’s progress.
Steady progress in Benin as more health workers trained to counter 'brain drain'
Benin is showing substantial and progressive improvement in reducing maternal mortality through strategies such as free primary education, free Caesareans and the training of more health personnel, said Benin's Minister of Health, Issifou Takpara. In spite of the medical school that is producing gynaecologists and skilled birth attendants, 'brain drain' continues to take its toll on the development of a health work force, he said. Delays in getting emergency care to rural women with complications continues to present challenges at the family and health facility levels, he said, adding that it can sometimes take an entire day just to sort through the lines of authority within the family or community before dealing with the difficult question of transport to the nearest facility. He also indicated that it is paramount that the donors community and financial institutions support countries' efforts and willingness to recruit more health professionals and to reduce financial barriers to emergency obstetric care.
Enlisting and training local women as health workers in Ethiopia
Increasing the number of trained medical personnel is major obstacle to improving maternal health throughout the developing world. Ethiopia, where maternal death rates have been reduced by over 50 per cent since 1990, is tackling that problem head-on by dramatically increasing the number of trained health workers in the country. The majority of these workers are young women, who have graduated from high school and receive one-year of training. According to Dr. Kessetebrehan Admasu, Director General in Ethiopia’s Ministry of Health, these health extension workers are critical to providing basic care, including maternal health and family planning services, and advising women on health issues for themselves and their children. In large part due to this effort, the contraception prevalence rate has doubled in the last four years. A key to the success of the programme is the fact that the health workers are salaried civil servants, which has improved retention and commitment.
Reducing mother-to-child transmission of HIV through integrated services in Botswana
AIDS is the leading cause of death among women of reproductive age worldwide. In some sub-Saharan African countries more than half of maternal deaths are attributable to HIV, and many newborns are born with the virus or acquire it from breastfeeding. Botswana launched a national programme on preventing mother-to-child transmission of HIV in 2000. Today, the mother-to-child transmission rate has plummeted to about 3 per cent. According to Dr. K.C.S. Malefho, Permanent Secretary of Botswana's Ministry of Health, the key to the programme’s success, efficiency and cost-effectiveness has been its integration into the strong antenatal care system that already existed in the country. The progress is commendable, but, as Dr. Malefho pointed out, “It is pointless to save a baby and let its mother die.” So the government expanded services to keep both mothers and children alive and healthy, such as infant nutrition programmes, guidelines for anti-retroviral treatments and improved delivery services.
Despite all the impressive progress, the country representatives addressed similar challenges they face as they build on the progress they have already achieved. Dealing with inequities in countries and getting services to the poorest of the poor was a major obstacle identified. In terms of financing, the need for additional and more predictable funding was echoed throughout the evening.
“The country presentations demonstrate that progress is feasible with political commitment, a sound national health plan, adequate financing and solid delivery,” said Purnima Mane, Deputy Executive Director (Programme) of UNFPA. With the new Global Strategy for Improving Maternal and Child Health launched this week, carrying strong commitments from donor countries and developing nations alike, there is reason to hope that the successes of these four countries can be replicated throughout South Asia and sub-Saharan Africa.