[afro-nets] New emphasis on maternal, newborn and child health

["MMI Thomas Schwarz" <schwarz@medicusmundi.org>]

New emphasis on maternal, newborn and child health: more than just another example of international rhetoric!

Despite some very recent advance in maternal mortality and neonatal mortality reduction, the health of many pregnant women and neonates is still bleak and far from achieving the envisaged MDG 4 and 5 targets by 2015. In sub-Saharan Africa alone, nearly 4.7 million mothers, newborns, and children die each year: 265,000 mothers die due to complications of pregnancy and childbirth; 1,208,000 babies die before they reach one month of age; and 3,192,000 children, who survived their first month of life, die before their fifth birthday. This toll of more than 13,000 deaths per day accounts for half of the worldâs maternal and child deaths. In addition, an estimated 880,000 babies are stillborn in sub-Saharan Africa and remain invisible on the policy agenda. 

Despite strong evidence of what works, serious gaps exist in coverage, quality and equity in providing effective health care along the continuum of care. To address this issue the UN summit held in New York last September ended up putting womenâs and childrenâs health high in the global agenda and adopting a clear strategy that includes: (a) support for country-led health plans with increased, predictable and sustainable investment; (b) integrated delivery of health services and life-saving interventions so women and their children can access prevention, treatment and care when and where they need it; (c) stronger health systems, with sufficient skilled health workers at their core; (d) innovative approaches to financing, product development and the efficient delivery of health services; (e) improved monitoring and evaluation to ensure the accountability of all actors for results. 

After years of hot debate around the effectiveness of global health initiatives, is this emphasis on maternal, newborn and child health well placed or just another example of international health rhetoric? This time it may be different for a number of reasons. 

First, the status of maternal and neonatal health is a good predictor of the functioning of the health system. The maternal health Millennium Development Goal is perhaps the one most dependent upon a well functioning health system (including the availability of facilities, medicines, supplies, staff, and a functioning referral system), so there are synergies in focusing on health systems strengthening and maternal and neonatal health in parallel. This parallelism is important, even if a lot remains to be understood about what health system strengthening means, how it could be done and evaluated and under what circumstances it works. 

Second, in the world of inequality of health services, maternal and child health services stand out as the âworst of the worstâ. Of these, of particular concern is access to emergency obstetric care. Here the gradient of inequality is very high. Among the reasons identified financial barriers appear to be the most critical one and different attempts are being tested to overcome them with a variety of approaches and results. In general, since out-of pocket expenditure for maternal health care services has driven many families into poverty, especially in developing countries, the international strategy is to push towards a policy of providing services free at the point of delivery. This âwomen and children firstâ is important since it may represent an opportunity to phase in universal coverage. 

Finally, in many settings poor women and children are among the most vulnerable members of the society. They are not listened about their needs and not involved in decision making about resource allocation. This is a âhuman right gapâ that needs to be addressed. The participation of poor women in decision making is important both because it empowers them and because it generates the social capital that is an important component of healthy societies. By enabling women and communities to address their own problems, the social cohesion and public action required to redress inequity more generally is generated.

In the end, focusing on maternal, newborn and child health seems to make sense from technical, political and human rights perspectives. However, without clarity on future directions, focus and energy could dissipate. For us who are working in international health cooperation action and evidence are needed on several fronts, such as:
- promoting interventions that address the whole health system not just some parts of it;
- influencing the demand side of the system; 
- fostering innovation and operational research on the main health care delivery issues at district and community levels;
- sustaining partnership between public and private non for profit (i.e. faith based organisations);
- measuring outputs such as coverage, equity and quality with validated and reliable tools; 
- sharing knowledge and results generated in the field for lobby and advocacy in the global health policy forum.

A lot remains to be done! 

References and resources: see MMI Network News, January 2011

http://www.medicusmundi.org/en/mmi-network/documents/newsletter/201101 

Author: Giovanni Putoto, Doctors with Africa CUAMM, 
mailto:g_putoto@yahoo.it