Dr. Gomes shares the Centre’s reactions to the recent Lancet publication that shows a dramatic reduction in global maternal mortality:
The Centre for Health Policy and Innovation acknowledges and welcomes the results and findings from the Lancet paper, published April 2010. However, we also would like to acknowledge that the scope of the study finds missing gaps and certain missed analysis which does not paint the full picture in research of maternal health and its barriers in reducing incidence of maternal and child death. Reducing “the rate of maternal mortality by 75% by 2015” is one of the development targets that has been endorsed at numerous international meetings. This target was selected because maternal ill health is the largest contributor to the disease burden affecting women in developing countries; because the lifetime risk of maternal death is much greater in the poorest countries than in the richest (1 in 12 for women in east Africa compared with 1 in 4000 in northern Europe); and because interventions are cost effective (costing £2 ($3) per woman and £153 ($230) per death averted).
The technical interventions needed to prevent maternal deaths are well understood. Traditional maternal and child health interventions, such as providing antenatal care and training traditional birth attendants, have failed. The availability, accessibility, use, and quality of essential obstetric care for life threatening conditions, including complications after abortion, need to be improved. What is less clear is how an environment can be created to enable interventions to be made in settings with few resources.
Creating a functioning health system is the most obvious means of providing this type of environment. Research conducted for the Centre for Health Policy and innovation indicate that most of the resources needed to improve essential obstetric care exist as integral parts of district health systems, even if some of the parts do not function well or need updating. In a functioning district health system the availability, accessibility, use, and quality of essential obstetric care are expected to be high and maternal mortality is expected to be low. Some developing countries, such as China, Sri Lanka, and Malaysia, have reduced maternal mortality dramatically after improving the coverage and quality of their health services. Conversely in Zimbabwe the progressive erosion of the general standard of health services has been associated with rising maternal mortality. Maternal mortality has been proposed for use as an indicator of accessible and functional health services.
In the long term, sustaining affordable improvements in safe motherhood depends on improving the functioning of health systems as a whole. Gains made in countries such as Malaysia and Sri Lanka were achieved by making maternity care a priority that guided changes in health services. Efforts to achieve similar gains in other developing countries need pragmatic support. Sector-wide approaches and other routes to health system reform, intended to offer alternatives to failing public systems and provide improved health services in a spirit of equity, are compatible with a focus on maternal health services. If performance, as measured by indicators of safe motherhood as well as other essential health indicators, was a condition of funding, the placing of maternal health services at the centre of the sector could be assured. In political environments in which partnerships between donors and governments are likely to succeed, sector-wide approaches present a unique opportunity for advocates of safe motherhood to make a sustainable impact on maternal mortality.