Investing in the health of mothers
04 January 2008
Africa Renewal (United Nations)
Listening to a mother's foetus in Liberia: African women not only need access to well-equipped health clinics, but also assistance from trained personnel who can recognize and deal with complications.
Pumwani Maternity Hospital, in Nairobi, Kenya, is the largest maternal health centre in East and Central Africa. Located close to Mathare and Korogocho, two of Nairobi's biggest slums, the hospital helps some 27,000 women give birth each year. Most are poor and young, between the ages of 14 and 18.
The government-run hospital struggles to provide even the most basic services, since it lacks sufficient resources, equipment and staff. "We told patients to buy their own things because of the shortage of supplies," explains Evelyn Mutio, the former head of the hospital's nursing staff. "We told patients to come with gloves, to buy their own syringes, needles, cotton wool and maternity pads."
The Pumwani Maternity Hospital exemplifies the state of the health infrastructure in Africa. According to the World Health Organization (WHO), high service costs, lack of trained staff and supplies, poor transport and patients' insufficient knowledge mean that 60 per cent of mothers in sub-Saharan Africa do not have a health worker present during childbirth. That heightens the risks of complications, contributing to greater maternal and child death and disability.
WHO estimates that in Nigeria, 800,000 women are living with fistula, a disabling condition often caused by problems in childbirth; the number grows by 20,000 each year. In Tanzania, 9,000 women die annually of complications related to pregnancy. Rose Mlay, the Tanzania representative of the White Ribbon Alliance, an international coalition on maternal health, says half of the mothers in the country have no access to medical facilities, because such facilities are too far away and the women lack adequate transport. And, she adds, "Even when attendants are present, they may not always have the training, skills or adequate.
Health care on bicycles
Despite scarce resources, some countries have been able to find ways to expand access to maternal health care. In Senegal, the Ministry of Health and the UN Population Fund (UNFPA) jointly fund the work of community health workers who bicycle to visit women in their villages. They are trained to monitor the health status of pregnant women, refer the women to local heath centres for preÂnatal checkups and ensure that they get to a centre where skilled attendants can assist with delivery.
"These volunteers come from the populations they serve," says Dr. Suzzane Maiga-Konate, UNFPA's representative in Senegal. "Sensitive questions that people would never ask an outsider, they ask them. And if we can reach people, we can raise the health status of this country."
In addition, UNFPA provides the villages with about $50 in seed money to set up community health funds. Villagers work out among themselves how to replenish the funds, usually through small monthly donations. The funds are used for emergency cases, such as getting a woman to a district hospital when complications arise.
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