The public health adviser of an international development agency? NGO(World Health Organization) in any "disadvantaged" country you like BUT NOT your own country (Afghanistan) has been invited to an in-country multi-stakeholder conference tomorrow to discuss how best to achieve ONE particular MDG (Maternal Health) by 2015.
How well the country has been performing on that MDG.
Public health issues that could be covered by that MDG and a case for prioritizing it.
Your agency's experience/commitment/ contribution to the goal worldwide and/or locally until now.
A suggested sustainable project or programme that has been successful elsewhere which might be adapted for adoption.
No more than 1000 words (preferably typed or printed in1.5 spacing).
25% will be awarded for each section.
The work must be referenced (this will mainly be a web search).
Handed in by 14th October, 2010.
No plagiarism!
How well the country has been performing on that MDG
(IRIN) - Almost a decade of donor funded health projects has resulted in a marginal reduction in maternal and child mortality, according to new estimates set out in a UN report on maternal health. Maternal deaths have fallen from 1,600 per 100,000 live births in 2001 to 1,400 in 2010, still the second highest in the world.
The infant mortality rate decreased from 165 per 1,000 live births in 2001 to 111 in 2008, while the under-five age mortality rate fell from 257 to 165 per 1,000, according to the report Trends in Maternal Mortality 1990-2008. [ http://www.unfpa.org/webdav/site/global/shared/documents/publications/2010/trends_matmortality90-08.pdf ]
Despite this progress, Afghanistan is still the world's worst place to be born. [ http://www.irinnews.org/report.aspx?ReportId=87198 ] The UN Children's Fund (UNICEF) ranked Afghanistan the worst of 202 countries in terms of maternal, infant and child mortality last year. UNICEF said [ http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf ] 1 in 8 Afghan women faced a lifetime risk of death from causes related to pregnancy and childbirth in 2009 which, according to the report, has improved to 1 in 11. "Unimpressive"
"Our progress in curbing maternal mortality has been slow and unimpressive," Suraya Dalil, the health minister, told IRIN, adding that progress on children's health had been satisfactory. Illiteracy among women, lack of roads, a shortage of female healthcare providers, poor quality health services and food insecurity are the main impediments to improved maternal health, she said. The country is committed to reducing maternal mortality to 800 per 100,000 live births by 2015 and to 400 by 2020, according to Afghanistan's MDG 5. [http://www.undp.org.af/MDGs/goal5.htm] Under-five mortality should be reduced to 127 per 1,000 in 2015, states MDG 4. [http://www.undp.org.af/MDGs/goal4.htm] Progress in reducing maternal mortality has been rated as 1 percent per year, far below the recommended 5 percent required to meet MDG 5, health experts said. "This is a positive trend but the progress is not fast," said Peter Graaff, country representative of the UN World Health Organization (WHO).
Public health issues that could be covered by that MDG and a case for prioritizing it.
Maternal mortality affects newborn mortality, progress on MDG 5 will also influence the efforts to reduce child mortality (MDG 4). Progress on MDG 5 is also related to MDG 6, which aims to combat HIV/AIDS and malaria, as these are important indirect causes of maternal death. Gender inequality is one of the social determinants at the heart of inequity in health. Progress in achieving MDG 3, promoting gender equality and women's empowerment, will help in achieving MDG 5. Maternal mortality is a sensitive indicator of inequality, as current statistics show that the poorest and least educated women have the highest risk of death during pregnancy or childbirth. Increasing primary education (MDG 2) for girls and eradicating extreme poverty and hunger (MDG 1) are means to empower women and will positively influence the achievement of MDG 5. ( World Health Organization )
The direct causes of maternal deaths are haemorrhage, infection, obstructed labour, hypertensive disorders in pregnancy, and complications of unsafe abortion. There are birth-related disabilities that affect many more women and go untreated like injuries to pelvic muscles, organs or the spinal cord. At least 20% of the burden of disease in children below the age of 5 is related to poor maternal health and nutrition, as well as quality of care at delivery and during the newborn period. And yearly 8 million babies die before or during delivery or in the first week of life. Further, many children are tragically left motherless each year. These children are 10 times more likely to die within two years of their mothers' death.
Another risk to expectant women is malaria. It can lead to anaemia, which increases the risk for maternal and infant mortality and developmental problems for babies. Nutritional deficiencies contribute to low birth weight and birth defects as well.
A majority of these deaths and disabilities are preventable, being mainly due to insufficient care during pregnancy and delivery. About 15 per cent of pregnancies and childbirths need emergency obstetric care because of complications that are difficult to predict.
Access to skilled care during pregnancy, childbirth and the first month after delivery is key to saving these women's lives - and those of their children. (http://www.unicef.org/mdg/maternal.html)
Your agency's experience /commitment/ contribution to the goal worldwide and/or locally until now.
WHO supports countries in improving maternal health and focuses on 75 priority countries that account for 97% of all maternal deaths worldwide. WHO aims to reduce maternal mortality by providing and promoting evidence-based clinical and programmatic guidance. The cornerstone of WHO's efforts to make pregnancy safer is the integrated management of pregnancy and childbirth (IMPAC), which includes guidance and tools to increase pregnant women's access to high-quality health services. In addition, WHO promotes skilled care at every birth. It has developed educational modules for midwifery training and offers training for trainers in midwifery education in the regions of WHO. Further, WHO promotes the approach of involving individuals, families and communities to increase access to quality care.
The World Health Assembly adopted WHO's global strategy to accelerate progress towards the achievement of international goals and targets in reproductive health (including the MDGs) in May 2004. Within this framework, WHO works to ensure that "by 2015 all primary health-care facilities are able to provide, directly or through referral, the widest achievable range of safe and effective family planning and contraceptive methods; essential obstetric care; prevention and management of reproductive tract infections, including sexually transmitted diseases; and barrier methods, such as male and female condoms and microbicides if available, to prevent infection" (based on a resolution adopted by the United Nations General Assembly). WHO's work involves conducting and building capacity in research and research synthesis, developing international clinical standards through evidence-based guidelines and assisting countries in implementing such norms within health systems. WHO also monitors progress towards reaching MDG 5 in collaboration with other United Nations agencies and programmes at the global level.
A suggested sustainable project or programme that has been successful elsewhere which might be adapted for adoption .
WHO promotes the involvement of individuals, families and communities in increasing access to high-quality care. To advance these approaches, staff of the WHO Department of Making Pregnancy Safer and WHO staff in the regions organize workshops to orient health programme managers and provide ongoing technical support to countries.
In August 2009 a two-year project was launched to improve maternal and child health in Kazakhstan. WHO/Europe provides technical support for the project, which is co-financed by the European Commission.
The aim is to support improvements in the health services for pregnant women, mothers, newborn babies and children. This will also assist the Kazakh Ministry of Health in achieving Millennium Development Goals 3-5, which aim to reduce child mortality and improve maternal health, using a gender approach. The project will focus on three pilot regions: Karaganda, South Kazakhstan and Aktobe.
Aims
The project aims:
to strengthen the health system in Kazakhstan in order to provide equal access to good quality services for women and children;
to give high priority to the needs of vulnerable groups;
to improve quality of care during pregnancy, childbirth, the postpartum period and childhood through the introduction of updated management guidelines on major complications; and
to support the Ministry of Health in developing and implementing a comprehensive maternal and child component in the national health strategy, in accordance with international standards.
Background
Following Kazakhstan's independence, the quality of the health services deteriorated, mainly because public funding was significantly reduced. Today, the system faces a number of challenges that influence maternal, infant and child health, including:
informal payments for health care;
regional differences when it comes to per capita allocations for health services;
uneven distribution of health facilities and the provision of health care workers;
insufficient access to pharmaceuticals.
At the launch, Hubert Petit, Chargé d'Affaires, Acting Head of Delegation of the European Commission to Kazakhstan, said: "The European Union has a marked interest in a political partnership and cooperation with Kazakhstan and central Asia, for several reasons. One of the reasons is our interest in promoting social development, which is why we have engaged in this project. Health is an integral part of social development."
Tamara Voschenkova, Vice-Minister of Health, said: "The problems of mother and child health are high on our agenda. We are not happy with the rate of reduction of the maternal and infant mortality in Kazakhstan. We know the WHO has some very effective tools to deal with these problems, which is why we have engaged in this joint project."
