Transcript South Asian Partnerships for Reducing Maternal Mortality

Towards Equity and Rights:
South Asian Partnerships for
Reducing Maternal Mortality
Maternal mortality in south Asia
South Asia has the highest concentration
of maternal mortality after sub-Saharan
Africa
 It is said to be responsible for almost half
of the estimated half a million maternal
deaths worldwide (Bhutta et al BMJ 2004)
 MMR ranges from 23 per 100,000 live
births in Sri Lanka to 539 in Nepal

India’s unique position
Considered a world-class health care
provider, but women are unable to access
the basic health care needed to avoid
maternal deaths and illnesses
 Has the highest number of maternal
deaths globally (WHO estimates 140,000)
 Strong political will required to ensure that
the 25 odd million births (and abortions
wherever needed) that take place each
year are safe

Political will for maternal health
“Maternal and Child Health is matter of
highest priority for our government …we
need a comprehensive approach to deal
with the painfully high levels of maternal
and child mortality … We have the
knowledge, we have the resources; what
is needed is a collective will …” –
Speech by Sonia Gandhi, Chairperson UPA
at the WHO meeting in Delhi 7 April 2005
Comparative data (Bhutta et al, BMJ 2004)
Est. 1000
births
MMR
% Skilled
birth
attendance
% TT
coverage
24489
440
34
73
Bangladesh 3504
600
13
85
Pakistan
5349
200
19
51
Nepal
82
830
9
65
Sri Lanka
328
60
94
91
India
Health and related expenditure
HDI
Per capita
exp health
2001
% govt
exp health
‘92-2001
% govt
exp on
defence
ODA in
mill.$
2001
Banglad 139 360$
esh
5$
5%
10%
1024
India
127 480$
4$
2%
16%
1705
Nepal
143 230$
3$
5%
5%
388
Pakista 144 410$
n
4$
1%
18%
1938
Sri
Lanka
15$
6%
18%
330
99
Gross
National
Inc/ capita
840$
What does the data indicate?
The fundamental obstacle remains the
willingness of the governments and policy
makers to give due importance to and apportion
resources for human development and public
health
 Investment in maternal and child health as a
central focus of public health policy is critical
 Lessons may be learnt from better performance
in other countries such as Sri Lanka

Strategies in Sri Lanka
 Maternity
(Senanayake, 2005)
Care including surgery and
blood transfusion is available free of
cost to every woman in Sri Lanka
 During their ‘high MMR’ stage, Sri Lanka
managed with a strategy of low level
skilled attendance
 Established foundations for
 Professionalized
midwifery
 Monitoring systems
 Advocacy
Strategies in Sri Lanka
 Gave
priority to improving access
to rural & marginalized groups
 Improvement of utilization of
available services by improved
quality of care
 Focus on Client Empowerment
(Demand side)
Maternal death Audit in Sri Lanka
Maternal mortality reviews from 1970:
 Visits to home and hospital for each
maternal death
 Detailed report and fact-finding
enquiry (not fault finding)
 Regional and national meetings to
plan remedial measures
Recommendations for 11th Plan
Empowerment of users through massive
public education on entitlements
 Training of all community birth attendants
(low to medium skilled) for ensuring that all
deliveries are covered
 Offer completely free comprehensive
maternal care including post-partum and
post-abortion care, to women, in accessible
institutions,
 User groups and Panchayats to monitor the
quality of care through Social Audit of
facilities and services in both public and
private hospitals in rural areas

Recommendations for 11th Plan
Use of IT (all ‘dais’ with special mobile
phones) for monitoring all births and for
improved referral to institutions during
complications
 Strengthen the system of auditing maternal
deaths (based on Sri Lanka model)
 Examine evidence from different parts of the
country to understand what works best
where – especially in rural, hilly, tribal,
conflict-ridden /disturbed, remote, poor or
urban slum areas

Recommendations for 11th Plan
Provide for learning opportunities and
exchanges/study visits for policy makers,
managers and providers to learn how to address
Maternal Mortality
(Especially from states with greater need to
improve maternal health services - EAG states
and Assam)


Strengthen the Civil Society – Government
interface on this crucial issue by
constituting a National Maternal Health
Task Force
WHRAP Policy Dialogues
Recognizing that the region has many similarities
in terms of problems as well as situation on the
ground  Policy makers, technical experts and officials
from Pakistan, Nepal, Bangladesh and India
have been meeting at Regional Policy Dialogues
 These are organized by WHRAP, a civil society
network in South Asia
 A Sub-regional Task Force is being formed to
take up the issue of maternal health and young
people’s access to SRH rights.
Thank you!
Jashodhara Dasgupta
SAHAYOG
Lucknow, UP