The East African Community (EAC) has registered a general improvement in maternal, newborn and child health, but there are areas in each member state that require sustained action for improvement, according to a recent report.
The Countdown to 2015 Report, A Decade of Tracking Progress for Maternal, Newborn and Child Survival, launched last month at the first Global Maternal and Newborn Health Conference held in Mexico, includes an updated country profile for each of the 75 countries, which jointly account for more than 95 per cent of the world’s maternal, newborn and child deaths.
The seventh in a series released over 10 years, it examines trends in mortality and nutrition; intervention coverage (including inequality); financial flows to reproductive, maternal, newborn and child health; and supportive policy and systems measures in 75 countries.
The report is intended to help policymakers and their partners assess progress, prioritise actions and ensure accountability for commitments to reduce maternal, newborn, and child mortality.
As is the case in nearly all other countries, all EAC countries have not ratified the Maternity Protection Convention, 2000 (No. 183), a modern international labour standard on maternity protection, which came into force in 2002.
According to the International Labour Organisation (ILO), expectant and nursing mothers require special protection to prevent harm to their infants’ health, and they need adequate time to give birth, recover and nurse their children.
Mothers also require protection to ensure that they will not lose their job simply because of pregnancy or maternity leave.
All the five EAC countries also suffer inequalities as regards skilled attendants at delivery between poor and rich households. Furthermore, in the entire EAC region and beyond, under-nutrition is mainly attributed to half of child deaths even though pneumonia is blamed for most under-five deaths.
Zulfiqar Bhutta, the co-chair of Countdown to 2015 Initiative, said worldwide maternal and child survival had improved by 50 per cent since 1990, but newborn survival and child nutrition remain the two major challenges that must be addressed.
Only four of the 75 Countdown countries — Cambodia, Eritrea, Nepal and Rwanda — will achieve both Millennium Development Goals 4 and 5, the report noted.
Regarding socio-economic equities, the report paints a positive picture for Rwanda when it comes to oral rehydration therapy (ORT) and continued feeding; measles; diphtheria-tetanus-pertussis (DTP3) immunisation coverage; early initiation of breast feeding; and antenatal care.
Rwanda has good policies, including community treatment of pneumonia, and postnatal home visits in the first week after birth, but still lacks an international code of marketing of breast milk substitutes, according to the report.
The Code is an international health policy framework for breastfeeding promotion adopted by the World Health Organisation in 1981 as a global public health strategy.
It recommends restrictions on the marketing of breast milk substitutes, such as infant formula, to ensure that mothers are not discouraged from breastfeeding and that substitutes are used safely if needed.
Rwanda registered 1, 300 maternal deaths in 2013.
The report shows that in 2013, general government expenditure on health as a percentage of total government expenditure was 22 per cent, while out of pocket expenditure as percentage of total expenditure on health was 18 per cent.
During the Mexico conference, Catherine Mugeni, the director of the Community Programmes Unit at the Rwanda Biomedical Centre (RBC), shed light on how 45,000 community health workers (CHWs) champion post-natal health in Rwanda by identifying all women in child bearing age, those who are pregnant and visiting pregnant ones three times during pregnancy.
She, however, cited insufficient supervision and mentorship by health care providers and a high turnover among the challenges to maternal and child health.
The way forward, according to Mugeni, includes “strengthening community-based maternal and newborn health service delivery through supportive supervision and mentoring.”
Reinforcing physician nursing home visit documentation and linkage with heath facilities, she said, is another good idea.
In Kenya, under-nutrition is mainly attributed to half of child deaths, while haemorrhage (25%) and hypertension (16%) are the biggest causes of maternal deaths. Post-natal visits for mothers – within two days – were at 51 per cent in 2014.
Government expenditure on health as percentage of total government expenditure in 2013 was six per cent, while out of pocket expenditure as a percentage of total expenditure on health was 45 per cent.
Dr Irene Mbugua, World Vision’s regional maternal, newborn and child health project coordinator, observed that equity gaps are wider for interventions that require access to health facilities or repeat contacts with a health provider than for interventions that can be delivered through outreach services at the community level.
“The community needs more empowerment which can only come about when citizens understand their rights and entitlements in the health delivery system. They need to monitor the standards at the health facilities and ultimately the two parties (citizens and duty bearers) need to get together and dialogue to look for sustainable solutions,” she said.
On equity, Tanzania only does well in closing the gap in use of insecticide-treated nets among under-five children between rich and poor households. But there are inequalities regarding even early initiation of breast feeding.
The country of 53.5 million people also lacks community treatment of pneumonia with antibiotics, according to the report.
Another policy deficiency is the lack of antenatal corticosteroids, medication given to pregnant women expecting preterm delivery, as part of management of preterm labour, a situation which often results in greater health risks for babies.
Most (39 per cent) of its maternal and newborn health expenditure is covered by external sources, while general government expenditure accounts for 33 per cent and private sources 27 per cent, according to 2012 statistics.
In 2013, out of pocket expenditure as percentage of total expenditure on health was 33 per cent and the country registered 7,900 maternal deaths that year.
Most (53 per cent) of Uganda’s maternal and newborn health expenditure is covered by private sources while government expenditure accounts for 24 per cent and external sources 23 per cent, according to 2012 data.
Out of pocket expenditure as percentage of total expenditure on health was 38 per cent in 2013.
The country recorded 5, 900 maternal deaths in 2013.
Regarding matters of equity, Burundi is an outstanding example as it registered a thin gap between rich and poor households as regards antenatal and DTP3 immunisation coverage.
At policy level, Burundi lacks in many respects. For instance, it has no maternity protection; no maternal deaths notification; no kangaroo mother care in facilities for low birth weight or preterm newborns; and no antenatal corticosteroids as part of management of preterm labour.