Monday, September 19, 2016

Maternal deaths crisis set in focus

Expectant mothers in the labour ward of a

Expectant mothers in the labour ward of a Tanzanian hospital. PHOTO | FILE 

By Janeth Mesomapya @TheCitizenTz

Dodoma. It has been explained that the escalating shortage of blood in various hospitals and health centers in the country has been one of the leading causes of maternal deaths countrywide.

Reports by the United Nations International Children’s Emergency Fund (Unicef) show that 24 women and 144 newborns die every day, implying that over 8,500 women and 50,000 newborns die yearly during delivery.

It has also been noted that 19 per cent of the daily maternal deaths are caused by the shortage of blood transfusion during the process. Blood transfusion is a life-saving process that is usually done to replace blood that has been lost due to severe bleeding.

It is also a treatment for severe anaemia that happens when the level of hemoglobin in the blood is lower than normal.

Despite a significant 47 per cent reduction of maternal mortality ratio (MMR) from 1990-2014 in the country, there’s still a great need to reduce the problem of maternal mortality.

Heath minister Ummy Mwalimu was quoted recently as saying that her office was working to increase accessibility of blood banks from zonal to regional levels in order to reduce the problem of searching for blood in faraway places, which for years has been claiming women’s lives. This was said during a seminar co-ordinated by the White Ribbon Alliance (WRA) in Dodoma last week. It brought together Members of Parliament and health sector stakeholders, to discuss the progress and way forward in promoting safe motherhood in the country.

The target by the WRA is essentially to ensure comprehensive emergency obstetric care (CEmONC) is available in all hospitals and health centers, starting with increasing the annual budget in the health sector that will directly touch CEmONC.

This CEmONC includes qualified staff involving midwives, doctors, anesthetists, laboratory technicians and assistants, with functioning infrastructure, including supply of tap water, electricity and labour wards.

It basically involves blood transfusion which directly requires refrigerators for storage, safe blood, transfusion supplies and functioning surgical theaters. When these are present, 80 per cent of death during delivery are minimized.

Currently, blood banks are only available in zonal hospitals while medical instructions require blood transfusion to be done in less than 2 hours from when it’s recommended for the patient.

“It is important for the blood banks to be nearby health centers, because in other areas, it takes more than 100 kilometers to reach blood banks, and considering poor roads are unreliable, it compounds the problem,” she said.

Along with that, Mwalimu mentioned that most hospitals and health centers had been facing a scarcity of theatres, a factor she said considerably magnified the problem. She explained that her office was in discussions with the World Bank to finance “We’re waiting for approval from the World Bank headquarters as its Tanzania office had already agreed to build 100 theaters to ensure that no woman dies as a result of complications related to theater shortages,” she said.

Following this development, the Health ministry has directed that any health centre that would not have a functioning theatre within the next six months would be degraded.

Giving a personal experience during the seminar, Dr Saphira Telatela said her life was saved in 2004 when she was giving birth to her second born at Aga Khan Hospital.

She said this was possible after immediate care of blood transfusion she received from on-duty medical attendants when she started over-bleeding right after she had given birth, saving both her life and the baby’s.

“I lost consciousness because of bleeding excessively, and since the hospital had all emergency requirements for maternal care, everything was done timely and effectively to rescue my life.

“If I were in a facility that didn’t have these basic facilities, things would be different. And if the government, health stakeholders and the public in general become serious, we can completely eliminate the problem in Tanzania,” she said.

A similar problem is being experienced in Wampembe Village off Lake Tanganyika in Rukwa Region, where generally blood can be accessed only in Mbeya Region, which is nearly 100 kilometers away.

The roads in that area are pathetic, entailing an eight-hour round trip by ambulance in order to save a woman’s life, who is medically able to be stable for only two hours as she starts bleeding.

In March 2014, the Alliance with the help of member organizations working in Rukwa conducted community petitions across all districts in the region, urging the government at national and local levels to deliver on the policy commitments for increased availability of CEmONC services.

More than 16,000 community members signed the petition, which was in turn officially presented to the then Prime Minister Mizengo Pinda during the national event commemorating White Ribbon Day in the region.

During his speech, the prime minister directed all councils nationwide to budget for increased access to CEmONC in their 2015 planning, and later the same month followed this up with a directive for prioritizing and delivering on safe motherhood actions across all mainland regions of Tanzania.

In the 2016/17 Comprehensive Council Health Planning (CCHP), a number of 48 districts are entirely excluded CEmONC in their budget.

In 2008, the government promised 100 per cent of hospitals and 50 per cent of health centers accounting to 700 to achieve availability of these CEmONC services throughout the country reaching last year, but so far there are only 159 which is 28 per cent offering these services.

Speaking during the seminar, the project manager, Ms Sizarina Hamis, said even the recent 19.6 per cent of the budget for these services are relocated to other activities instead of the actual target in the councils.

“The government should start prioritizing this area, if at all the national target is to diminish maternal deaths. It is an unavoidable responsibility to save the lives of women who fulfill their biological duty,” she explained.

Another considerable factor that hinders maternal health is scarcity of well skilled health attendants, who often times don’t meet the standards of performance required in the spectrum.

Tanzania is experiencing a health workforce crisis, with a projected shortage of more than 82,000 health workers, equivalent to 56 per cent shortage of all health workers as against minimum requirements.

It is evident that Tanzania is struggling to provide skilled care at birth to significant numbers of pregnant women, as well as emergency and specialized services for newborn and young children. This has direct consequences on the numbers of deaths of women and children.

Furthermore, the skilled health workers employed by government are inequitably distributed across the country with extreme shortages in rural and remote health facilities, especially dispensaries. There is a clear regional disparity with regards to skilled health worker availability,

Minister Mwalimu discussed this problem during the seminar and said the government is working to both increase the number of health attendants especially in the remote areas as well as conducting trainings for capacity building.

This is to ensure that health services are provided at the best standards possible while using the same limited resources and workforce presently available in the facilities.

The focus will also be put on providing more awareness to wananchi, especially in rural areas, on maternal health-related norms and beliefs that actually endanger the lives of pregnant women, like taking herbs before and during labour pain.

Under the new Strategic Plan 2016/2020, WRA will advocate the assurance of adequate investment in the maternal and newborn health on delivering commitments made in national strategies to dramatically reduce maternal and newborn deaths.