Transcript Document

Potential roles for professional
associations in South Africa –
making a difference to maternal
health
Sharon Fonn
• Raise the status, maintain the integrity,
support and promote the interests of the midwife
• Develop and promote an adequate, efficient
and effective midwifery service in South Africa
• Consider every matter in connection with or with
reference to midwifery and act as an advisory
body
• Bring about liaison and cooperation with
other groups and health care providers
associated with midwifery
• Encourage the establishment of local groups in
order to promote the aims and goals of the
Society
• Promote research in midwifery
•
Promote liaison with midwifery groups
internationally
National agenda - improving maternal and
child health
• MMR is decreasing in
some countries
•
• WHO - 3 common
factors present
1. Policy makers and
health service
managers prioritize
this
2. Skilled providers who
operate in a
professional manner
3. Access to services and
related resources
Professional associations can and
should play a role in achieving this
• “Because the country is in
need of critical mass of
leaders, the days of
treating nurses as mere
implementers of policy
that is already exists are
long gone, and it’s time
for nurses to take up a
leading role in solving
the country’s health
problems in support of
existent programmes.”
• Thembeka Gwagwa,
General Secretary of
Democratic Nursing
Organisation of South
Africa (DENOSA),
Professionals have an obligation to
act
Under what auspices do professional
associations do this?
Human Rights framework
• Failure to reduce preventable maternal
deaths violates women’s right to
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Life
Health
Non discrimination
Equality
Under what auspices do professional
associations do this?
• Human Rights instruments (CEDAW) provide
mechanisms (and responsibilities) for the public to
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Monitor
Scrutinize
Document progress
Report (nationally and internationally)
Working in alliances can make a difference
– any examples?
Pressure from coalitions
– Women’s organizations,
– Health and legal professionals
– Parliamentarians
– Church groups
• In UK quality of care
and patient satisfaction
indicators are now
standard audit tools
used by health
professionals
• In South Africa and
internationally saw
abortion law reform
Did it make a difference ?
Reprod Health. 2011; 8: 39.
Published online 2011 December 22. doi: 10.1186/1742-4755-8-39
Did it make a difference to maternal
mortality?
• Choice on Termination of Pregnancy Act in
1996
• Maternal mortality due to unsafe abortion
down by 91%
• Maternal morbidity due to unsafe down by
50%,
• Safe TOPs increased by 67%. 26 401 to 81 900
in 1 year
Other examples?
• HIV services – a coalition of lawyers, health
professionals, clinician associations,
community members, NGO’s worked together
to ensure that women got access to
prevention of transmission to their children
and then treatment for themselves and others
• Community – provider links (treatment
literacy campaigns)
Other mechanisms?
• UK confidential enquiry published every three
years since 1952
• Target medical and midwifery professions who
responded by improved training and M&E
• Consistent and sustained decrease in MMR
Confidential enquiry into maternal deaths
in South Africa
Recommendations
• Protocols available and used
• Training (anaesthesia)
• Screening and Rx for non pregnancy related
disease
• Referral
• Staffing and equipment norms
• Blood
• Contraception
• Abortion deaths
• Community involvement
YET
2005-2007
recommendations almost
identical to
2002-2004
Enquiry necessary but not sufficient
• In South Africa and Botswana we have the
reports but as yet not the required response
• Some don’t want to change
• Many are prevented from doing so –
conditions prevent providing quality of care
Need to mobilize around maternal
deaths
Does anyone do it?
Uganda May 2011
• By not providing
essential medical
• Hundreds of health
commodities and health
professionals and
services to pregnant
concerned citizens went
women their
to the constitutional
constitutional rights are
court in Kampala to
being violated
support a lawsuit which
is trying to hold
government responsible
for the death of 2
women who bled to
death
Professional associations’ role
• Commitment to
professional
competence
• Providing quality care
• Who holds them
accountable?
• Governments have a
duty to create
conducive
environments to allow
for providers to act in a
professional way
• Health professionals
should be accountable
for the standard of care
they provide
• Speak out about abuse
Why do it?
• Raise the status,
maintain the
integrity, support and
promote the interests
of the midwife
Changing policy and practice
• Who are the allies who
can be relied on to
support professionals?
• Learning from HIV
• Bring about liaison
and cooperation
with other groups
and health care
providers associated
with midwifery
Anyone done it?
• SA Human Rights report
• Kenya a similar report –
– Removal of user fees
– Midwives association invited Federation of Women’s
Lawyers to do training on a rights based approach
– Public enquiry on sexual and reproductive health in
June 2011
– Coalitions formed and partnerships developed –
indication of improved quality of care
Challenge protectionism
• Nepal 1996: 3-month training for anaesthetic
assistants
• Provided anaethesia for thousands each year
including caesarean sections
• Physicians opposed this
• Nepal’s safe motherhood initiative, alliance of
health professionals and NGOs ensured they
were reinstated and accredited
If we are serious about our profession
• Incumbent on us to act in defense of what we
do and how we do it
Lastly – dealing with indirect causes of
Maternal Mortality
• Comprehensive care
– Contraception
– HIV
– TB
– Chronic diseases
– Our patients are people
How
• It starts with me ….
Role model
• Explain the reasons for the baby-friendly initiative
• A new style of engagement: “customers”,
“service”
If I behave the right way and you keep on seeing
me behave the right way towards the patients:
being customer friendly, the patients talking to
me, being happy, greeting me, I greeting them.
Then you’ll also think, is this not nice?’ It won’t
be everybody changing but most of the nurses
will think, ‘hey, this is good’ and they’ll also
change.
B Harris Centre for Health Policy
Thank you