Shall new global plans result into better survival for mothers and babies in Uganda?
Mrs G is in her final three months of pregnancy. She has an ‘infectious’ smile that usually brings warmth around those who know her in her neighbourhood. But that smile could soon turn into sadness.
Mrs G and her unborn child could easily contribute to the grim statistics of maternal and newborn deaths that are ravaging the global community. Mrs G could experience a still birth; her baby could die just before, during or immediately after child birth, and she could also die during the same period. If they survive they might do so with lifetime injuries or morbidity resulting from a labour and delivery process gone wrong.
And Mrs G could come from anywhere. But she is most likely to come from a low income country. Mrs G is indeed the representative of a universal mother.
Despite international efforts to save women and newborns over the last couple of years and marked improvements, nearly 3 million babies still die in the first month of life and 2.6 million babies are stillborn each year world over. Statistics further show that newborn deaths now account for 44% of all deaths among children under the age of five. In addition, 287,000 women die annually from complications of pregnancy and childbirth.
With now less than 500 days to the deadline set by UN member countries to achieve 8 millennium development goals, among them reducing child mortality and improving maternal health, it is apparent that many targets will not be met. This calls for new initiatives to address the plight of the nearly 300,000 families with Mrs Gs for the post 2015 era and beyond.
One such global initiative is the Every Newborn; an action plan to end preventable deaths which was launched during Partnership for Maternal, Newborn & Child Health Partner’s Forum (PMNCH) in Johannesburg, South Africa in June 2014, following approval by about 190 countries and organisations a month earlier at the World Health Assembly under the auspices of the World Health Organisation.
“The Every Newborn action plan clearly lays out what needs to be done differently, and which efforts and investments have the greatest impact, with a triple return on saving women and newborns and also preventing stillbirths,” Professor Joy Lawn of the London School of Hygiene & Tropical Medicine and senior health advisor to Save the Children, also lead author of The Lancet Every Newborn Series, was quoted saying at the launch of the action plan.
Graça Machel, co-chair of The Partnership for Maternal, Newborn & Child Health, endorsed the vision of the Every Newborn action plan in her opening comments at the Partners’ Forum. “This plan demonstrates that together we can achieve the vision of a world in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies and children survive, thrive and reach their full potential.”
Every Newborn was designed in such a way that whoever can make a difference in the health of mothers and new-borns is a stakeholder. The initiative is designed to support “government leadership and the actions of policymakers and program managers and provides technical guidance to inform the sharpening of existing health sector plans and reproductive, maternal, newborn and child health (RMNCH) strategies, if required.”
It (the plan) outlines key partners including health professional associations, academic institutions, multi-lateral and bilateral agencies, foundations, the private sector and civil society, including women’s and parent’s organizations, to ensure broad ownership.
However, the Every Newborn plan is complemented by Targets and Strategies for Ending Preventable Maternal Mortality (EPMM) by the WHO and partners, agreed at a meeting in Thailand in April 2014. The meeting aimed at forging consensus on maternal mortality reduction targets for inclusion in the post-2015 development agenda. The other aim was to identify maternal health strategies that would assist countries to achieve those targets.
EPMM anticipates among other things an average global target maternal mortality ratio (MMR) of less than 70 maternal deaths per 100 000 live births by 2030. Similarly, at national level, by 2030, no country should have an MMR greater than 140, a number twice the global target.
The initiative further stipulates that for countries with MMR less than 420 in 2010, there is need to reduce the MMR by at least two-thirds from the 2010 baseline by 2030. And, for all countries with baseline MMR greater than 420 in 2010, “the rate of decline should be steeper, and in 2030, no country should have an MMR over 140.”
Dr Peter Waiswa, a lecturer at the Makerere University School of Public Health, noting that the new plans are not without precedent, wonders whether these initiatives drive governments as the millennium development goals fade away with modest achievements.
The academic observes that the initiatives come in the same setting of still struggling health systems with limited resources especially personnel, money, and commodities, amid weak leadership.
So what is the way forward if Uganda and the developing world are to improve maternal and newborn health indicators? Dr Waiswa avers until governments understand what needs to be done and commit resources, these plans will not change much.
“In the case of Uganda, the challenge is huge. First, our health system is poorly funded, has weak management, quality of care and capacity of facilities is inadequate, and we have high fertility and a high burden of co-morbidity,” says the academic, whose research interests include maternal and newborn health.
Dr Waiswa further says that reducing maternal and newborn mortality must include rapid scale up of family planning and addressing adolescent pregnancy.
The private sector whose role is increasingly being appreciated, he adds, must not only be harnessed but also needs strengthening.
In our next feature we shall look at the Reproductive Maternal, Newborn and Child Health Sharpened Plan for Uganda, which almost a year after its launch, is yet to make baby steps.