The heart of SA health

Zohra Mohamed Teke

According to the World Health Organisation (WHO), the deaths of about 1 500 women every day around the world owing to pregnancy-related complications, could have been prevented.

In KZN, almost 60 percent of all maternal deaths in the province are preventable.

The issue of maternal health is among the most formidable challenge that the government has to contend with and SA’s launch of its campaign today to reduce these deaths pulls no punches.

Attending this week’s regional launch of a Campaign on Accelerated Reduction of Maternal, New Born and Child Mortality (Carmma) were senior southern African delegations, UN officials and local dignitaries.

The driving force for the local campaign, says KZN Health Department head Sibongile Zungu, is that SA’s campaign will be evidence-based: taking it from a position of policy and shop talk to one where interventions and strategy can be measured through outcome-based results. It marks a turning point for SA, and KZN in particular, with its high rate of disease burden.

Some of the key features of the SA campaign will include:

l Strengthening access to a wide range of sexual health services, especially family planning.

l Promotion of early antenatal care attendance and booking.

l Better access to skilled birth attendance through the provision of obstetric ambulances to every facility where deliveries are conducted.

l Establishment of maternity waiting homes where necessary.

l Strengthening human resources for maternal and child health through training.

l Promotion of breast-feeding.

l Intensifying efforts to manage HIV-positive mothers and children through improved access to treatment and management of co-infections.

l Elimination of mother-to-child transmission of HIV.

The package of measures is a major boost, especially for women in rural areas who are affected the most by maternal deaths.

With at least 54 percent of KZN’s population living in rural areas, getting health services to them has historically been a daunting task.

Slowly, the paradigm has shifted and mobile clinics now play a big part of health service delivery to these areas, where the terrain does not allow for the building of clinics or permanent health facilities there.

However, despite the progress, there is concern that without addressing other issues linked to maternal deaths like HIV, the challenge to reduce maternal mortality will be difficult to overcome.

A recent report by the government’s leading international funder, the US-based Henry Kaiser Foundation, bears testimony to the treacherous conditions our Health Ministry faces. The findings state that while the prevalence of HIV has peaked and there are indications of significant declines among younger people, the magnitude of the epidemic “will continue to dwarf other causes of mortality for the next decade at least”.

“The number of deaths from Aids will continue to exceed 300 000 per annum, even if 90 percent ART coverage is achieved. While this would curtail any further growth in mortality and mean a saving of 200 000 lives a year, the total number of deaths each year would still be about the same as today.

“The only way in which the burden of Aids will be reduced from current levels is by preventing new infection. This must be the main aim of efforts to reduce the burden of disease in South Africa.”

For many critics, the campaign may seem ambitious, especially within the constraints of human resources and financial challenges.

SA is already under extreme pressure to meet its Millennium Development Goals adopted by world leaders in 2000 as a way of tackling extreme poverty by 2015.

Zungu is under no illusion that the campaign to reduce maternal deaths is far from where health service should be in KZN.

“Yes, the (development goals) talk about reducing maternal mortality by two-thirds by 2015.

“Our campaign wants to reduce this by 75 percent. We may seem ambitious because it’s tough given our constraints, but we cannot sit back and do nothing because we are faced with these obstacles.

“We do have to turn the tide despite the odds against us, and despite the stats that are demoralising for those health workers who continue to give their all in the hope of making a difference.

“Yes, there are times when we feel that we were going one step forward and two steps back, but we have to persevere, and although we have a long way to go, we have made progress – and that is a huge milestone that we must use as a catalyst to continue.

“Saving mothers and children is of particular focus for us because this is at the heart of health care. Our launch of this campaign to save mothers and children is not the start. Our former president, Nelson Mandela, set the wheels in motion for this when he declared free health care for all pregnant women as far back as 1994.

“The campaign that we are now launching serves to speed things up so that we increase the momentum of our effort and ensure that the call for participation is heeded by all – society, community organisations, health, government, media – we are all responsible to try to prevent pregnant women from dying,” said Zungu.

Efforts in KZN are bearing results. In 2008, the rate of transmission of HIV from mother to child stood at 21 percent. Today, barely four years later, this figure has dropped to 3 percent.

The new campaign is being hailed as a significant push towards reducing maternal and child deaths, and despite the many obstacles and constrains that lie ahead, it needs to be applauded – it’s a step in the right direction.