The situation in Guyana, South America
As a health volunteer for the United State Peace Corps, I assist a team of doctors, midwives and nurses in delivering basic health care to a local community in Guyana, South America. Every week at the health center, there are three clinic days dedicated to providing antenatal care, family planning and newborn vaccinations. Approximately 10–30 women come to the antenatal clinic per week and according to the records, the health center saw 184 pregnant women in 2017. The only available statistic that addresses noncommunicable diseases (NCDs) in the context of maternal health for this population is the testing rate for anemia—in 2017, 76 out of 184 women were tested.
Every week, several women at the health center present signs of pregnancy induced hypertension, anemia, obesity and other NCDs, such as depression or anxiety. However, data reports for the health center are limited because our indicators do not target NCDs in the antenatal population. Regular reports are viewed as burdensome and compulsory, rather than as a tool to better understand the population and its health needs, and outdated metrics continue to be used. This contributes to an overall reliance on basic maternal health guidelines—such as the proportion of pregnant women receiving antenatal care—as benchmarks for quality of maternal health care in Guyana. This trend is consistent with research showing a quality-coverage gap in antenatal care on a global scale, particularly where resources are limited and quality data collection remains challenging.
In 2016, the maternal mortality rate in Guyana was 116 per 100,000 live births. Fortunately, there is a high utilization of antenatal care. In 2014 90.7% of women age 15-49 were attended by a skilled health personnel at least once during pregnancy and 92.4% were attended by a skilled birth attendant at their most recent live birth. Access to a health facility to see a skilled birth attendant is typically not a major barrier to care because health care coverage is free and health infrastructure supports this demand. In some regions, Amerindian maternity waiting homes accommodate women planning to deliver in the coastal hospital and after they return to their rural communities.
Filling the data gap to meet local needs
Guyana Ministry of Health officials have identified the need to focus on NCDs in the general population. While this action points Guyana in a positive direction, priority must also be given to adapting monitoring systems within the primary health care system. Quality data surveillance and monitoring is required to best understand multiple, overlapping vulnerable populations, such as individuals with NCDs and women of reproductive age in developing countries. This overlap holds potential to address complex health topics with sustainable solutions, but only if the knowledge gap is filled.
Increasing data collection in primary care
Implementation strategies to improve utilization of evidence-based guidelines and focus on capacity building might include in-service training, supportive supervision, appropriate checklists, accountability processes and financial incentives. Innovations within the field of health technology, such as mHealth, could be used for quality data collection and surveillance to improve health statistics.
High quality maternal health care requires a health workforce and health systems that adequately respond to local needs and can meet emerging challenges, such as those at the intersection of maternal health and NCDs. Guyana’s health system structure has serious potential to evaluate and respond to these complex health issues, but decisions concerning resources and strategies require evidence-based support, highlighting the demand to improve data quality measurement tools and methods.
Further research is required to drive improvements in health system monitoring and appropriate guidelines in countries with limited resources. Investing in strategies that support quality health assessments will help to close the evidence gap in maternal health and enable health care providers to advance sustainable solutions and better health outcomes for the women, their families and communities.
“The contents of this blog post are the author’s and do not reflect any position of the United States government or the Peace Corps.”
Edited by Kayla McGowan, Project Coordinator, Women and Health Initiative, Harvard T.H. Chan School of Public Health
Photo credit: Elizabeth Marcuse/United States Peace Corps, Guyana, South America.
Browse other posts in the MHTF’s “Noncommunicable Diseases and Maternal Health” blog series.