Action, not words, will improve maternal and child health

Monday July 26 2010

By Muniini K. Mulera

Dear Tingasiga,
The failure of Africa’s rulers to meet the health needs of our women and children was underscored by a story that participants in a Gender Is My Agenda Campaign (GIMAC) meeting in Kampala heard on July 22. According to Ms Robinah Rubimbwa, my great friend who attended the GIMAC meeting, a woman who had travelled in a caravan from Nairobi, via Dar es Salaam and Kigali, narrated a heart-wrenching incident she and others witnessed as they travelled through Mbarara.

When the women visited Mbarara Hospital, they were impressed by the cleanliness and orderliness of the Labour Ward, with one woman per bed. However, when they visited the postnatal ward, they discovered a whole different world. Each bed in this filthy ward accommodated two new mothers. The floor was filled to capacity by more women who had delivered their babies in the preceding 48 hours. Some of the floor dwellers had just delivered by Caesarean Section. These new mothers had no where to place their babies.

As they left the hospital, the travellers met a group of people at the gate. They were carrying a woman, Anna, who had been in labour at home for four days. Anna was a mother of seven, of whom the last three had been delivered by C-Section. Among the women in the caravan was an obstetrician/gynaecologist who asked how long Anna had been in labour and why her attendants had not brought her to hospital sooner. They told the obstetrician that they had thought that Anna would deliver easily.

Presently, Anna was helped to the labour ward. It took another hour to get the duty doctor to examine her and declare that she needed to go to the operating room for another Caesarean Section. Unfortunately the operating room was occupied. Therefore she had to wait. One hour and twenty minutes later, Anna was wheeled into the operating room. She died during surgery, leaving behind seven young children with their peasant father, who is likely to marry another woman to give him another five children.

Anna’s death from pregnancy complications was one of thousands that occurred that day across Africa. Of the world’s 529,000 women who die every year from pregnancy-related causes, 50 per cent are in sub-Saharan Africa. Uganda loses at least 6,000 women every year due to reproductive problems.

That Anna died in the week when Africa’s rulers assembled in Kampala for one of the most extravagant displays of African hospitality, during which they made declarations of their commitment to save the lives of people like her, reminded us of the disconnect between governments and their subjects. No doubt the African Union’s focus on the high maternal and child mortality rates on the continent is a welcome development. However, one hopes that Africa’s rulers will move from talking to providing the practical solutions to the problem. After all the high maternal and child death rates is not news to anyone. The ugly data of death, disease and disability to which millions of African women and children are condemned every year has been available for decades.

Government departments have religiously churned out reams of annual statistics that ought to have informed the budget allocation and priority goal setting. The World Health Organisation has faithfully provided excellent data that has consistently painted a bleak picture that ought to have persuaded the political leaders to act a long time ago.
African health care professionals and researchers, including our own experts at Makerere Medical School, have published first class, peer reviewed papers on the subject, not only detailing and analysing the bleak statistics, but also offering preventive measures.

Neonatology, the science and medicine of unborn and newborn babies, being my profession, I, like thousands of my colleagues, have used every opportunity to address this problem through writing and through discussions with various government leaders in Uganda and other African countries to highlight the problem and to offer possible solutions.

Furthermore, African leaders, many of whose parties or armies have been in power for more than a decade, did not need us to tell them about the scope of the problem. They were signatories to the United Nations Millennium Declaration of September 8, 2000, which committed their nations to a new global partnership to reduce extreme poverty and set out eight time bound targets to be achieved by the at 2015.

These eight Millennium Developmental Goals (MDGs) were to (1) eradicate extreme poverty and hunger; (2) achieve universal primary education; (3) promote gender equality & empower women; (4) reduce child mortality by 2/3 of the rate in 2000; (5) improve maternal health, including reduction of maternal mortality by 3/4 of the rate in 2000; (6)combat HIV/Aids, malaria, and other diseases ;(7) ensure environmental sustainability; and (8) develop a global partnership for development.

The irony then is that in July 2010, these same African leaders gather in Kampala to talk about and to commit themselves to the very goals to which their countries, and in most cases the very same rulers, signed their names 10 years ago. Unfortunately, five years and 158 days to the target date of achieving the MDGs, most African countries are off track and will not achieve Goals 4 and 5.

There is some good of course. Cape Verde has already achieved MDG 4 and 5. Rwanda, Ethiopia, Mozambique and Gabon are among those which are on track and are very likely to achieve these goals by 2015. Angola, Botswana, Congo Brazaville, Cote D’Ivoire, Kenya and Zambia could achieve these goals if they made specific changes. On the other hand, Benin, Cameroon, Chad, Congo Free State, Ghana, Lesotho, Nigeria, Tanzania, Uganda and many other African countries are off track and are very unlikely to achieve these goals. Why are Africa’s women and children dying and what can be done to reverse the trend?

To be continued…

Dr Mulera is a consultant pediatrician and neonatologist