ETHIOPIA:Solidifying Commitments to Ensuring Zero Maternal and Newborn Deaths

July 2014 TheReporterEthiopia; Just picture yourself in one of the Ethiopian villages where someone is giving birth without a midwife, and think about possible complications in pregnancy as many women often stay in prolonged labor.

Moreover, there is no access to a health post and poor infrastructure to reach out to. On the other hand, picture yourself in a certain village where a mother is giving birth and suddenly the mother finds out that her new baby isn’t breathing, moving or crying. She screams out for help and a midwife comes in to check on her. Thanks to the midwife’s quick and skillful treatment, the baby starts crying. Fortunately, the baby has survived. How shocking it is to hear that there are 800 women dying daily while giving birth, and pregnancy complex across the world? The more horrifying news is that 2.9 million newborn babies (first 4 weeks) die and 2.6 million are stillborn (last 3 months of pregnancy). Globally, newborn deaths of children under 5 years now account for 44 percent. Moreover, the day of birth is the time of greatest risk of death and disability for babies and their mothers – contributing to around half of the world’s 289,000 maternal deaths. And that is why Nana Taona Kuo, senior manager of Every Women Every Child in the executive office of the secretary-general said, “There is no more poignant time now for all actors to do everything they can to end the preventable deaths of women, newborns and children within the generation. The greatest wealth a nation can have is the health of its people.”

The Partnership for Maternal Newborn and Children Health (PMNCH) is an alliance of more than 625 organizations from the reproductive, maternal, newborn and children health communities. Earlier last week more than 800 participants gathered in Johannesburg, South Africa, to assess progress to date and ensure women and children remain central to the post-2015 development agenda. Since September 2005, the Partnership has played an important role in maintaining progress toward improved Reproductive Maternal Newborn Children Health (RMNCH) across each of its three strategic objectives: Knowledge Documents, High- Level Advocacy, and Promoting Accountability. The Partnership also played a key role in the development of Every Newborn Action Plan (ENAP,) a road map to save the lives of 3 million newborns and women each year. From left: Aeron Mothsodoli, Tedros Adhanom and Margareth Chan

The Partners’ Forum was focused on various issues related to success and setbacks of maternal and newborn health. More importantly, it reinvigorated its effort to call up for more commitments and their speedy implementation. “Still much more remains to be done despite all efforts,” Graça Machel, chairwoman of the Partners’ Forum, said in her opening speech. The inadequate coverage that has been given to women and children worldwide is still a challenge in failing to ensure that all women, adolescent girls, children and newborns, no matter where they live, are able to fulfill their rights to health and education and to realize their full potential. “That’s why we need a partnership, more strong partnership to empower ourselves ahead of the challenges,” she pointed out. The world has been especially slow in improving health outcomes for newborns. Globally, each year, 2.9 million newborns (first 28 days of life) die and 2.6 million are stillborn (die in the last three months of pregnancy or during childbirth). Recent data published in The Lacent, the leading health journal’s, Every Newborn Series indicates that 15000 babies are born and die every day without ever receiving a birth or death certificate. The accompanying analysis found that 3 million maternal and newborn deaths and stillbirths in 75 high burden countries could be prevented each year with proven intervention that can be implemented for an annual cost of only USD 1.15 per person. Since its launch in 1997/98, Ethiopia Health Sector Development Plan (HSDP) has prioritized RMNCH, improving the quality of services and access to them. The HSDP has strengthened areas such as immunization, nutrition and community and facility-based services. Because of its investment in training and expanding its health workforce it has written its success stories amongst the few countries worldwide. The Health Extension Programs (HEP) in Ethiopia was launched in 2004 with support from the development partners. Promoting community-based primary care through salaried health extension workers (HEWs) who are mostly women, it has become a country in the forefront to impart the success stories. Since then more than 38700 HEWs have been deployed and more than 16000 health posts have been constructed. As a result, the percentage of women making four or more antenatal visits has nearly doubled between 2000 and 2011 and contraceptive coverage for modern methods quadrupled from 6 per cent to 27 percent over the same period. Despite the laudatory success the country has recorded in a decade’s time, it still has one of the highest maternal mortality rates on the continent at 676/100000 births. “We performed one of the most difficult missions and responsibility,” Tedros Adhanom (Ph.D.) former health minister and current minister of foreign affairs addressed the crowd in his speech in Johannesburg. Since his departure from the ministry a year and a half ago to become the foreign minister, his leadership is still being recognized as one of the reasons for the successes. He often attends health conferences and forums to impart skills and leadership and ownership. “I feel I’m together with the family I belong to whenever I’m with you,” he said. Indeed, he has always mentioned in various speeches and interviews dealing with healthcare. Under his leadership the country managed to reduce under-five mortality rate by 47 percent to 88/1000 live births between 2000 and 2011. “We really look to have a strong and dedicated leadership to deal with the issue everywhere,” Christopher J. Elias (MD, MPH), President Global Development, Gates Foundation, said.

More importantly, the HEWs in Ethiopia are closely involved in delivery of the National Nutrition Program (NNP), launched by the government in 2008 aiming at tackling malnutrition. The NNP has then taken a multisectoral approach and moved away from an earlier focus on food aid. In five years, the program has extended from 39 to 228 districts; by 2012, 71 per cent of children aged 6-59 months were receiving vitamin A supplements and 52 percent of children aged 0-5 months were being exclusively breastfed to reduce the prevalence of stunting from 58 percent in 2000 to 44 per cent in 2011 with a similar decrease in underweight children. Nevertheless, this will not guarantee the future and those countries, including Ethiopia, have to remain more committed and recuperated. Some even point their fingers at the turnover of the trained physicians, midwives, and health extension specialists who travel to other African countries in an attempt to share experiences. Malawi, Namibia and some Southern African countries have long been a destination for Ethiopian health care specialists. “You can’t stop it; you can train more and more,” Christopher added. The Partners’ Forum appeared to be in accord with the governments forwarding quip-remarks revealing commitments and determinations are yet to be solidified. “The business is unfinished. We need to realize them all,” Amina Mohammed, UN Special Advisor, Post-2015 Development, said. While launching The Every Newborn Action Plan-endorsed by 194 countries in May 2014 Partners’ Forum marked a historic global commitment to ending preventable newborn deaths, believed to produce a potential to preventing nearly 3 million deaths of mothers and newborn babies and stillbirths a year. Now, Every Newborn’s targets include saving 75 percent of babies who are not breathing when born by 2025, providing quality medical care within two days of birth for 90 percent of mothers and their newborn child by 2025, having a midwife by the side of 95 percent of women by 2025, no more than one children in every thousand will be stillborn, and no more than ten will die on their first day of life by 2035. Quite impressive as it sounds, nonetheless, it still needs unwavering commitment and quick implementation from governments, as the chairman of the Partners’ Forum repeatedly said, “We need to put more pressure on governments with some tardiness.” To make sure sustainability, particularly in the ten fast-track countries, government and stakeholders should put more effective platforms and mobility in place, according to health experts. Ethiopia, claiming the top-five spot of those countries also advised to pursue and expand its community-based primary care for women and children through health extension workers and building upon present health posts to reach out to its vast land and dispersed communities to achieve the Post-2015 MDG, taking lessons from its shortcomings in missing the MDG agenda previously set up by the UN. According to the Nigerian-born Amina, social inclusion, decreasing poverty and access to health care and nutrition should go in line with the African Union’s (AU’s) 2050 economic transformation agenda for the continent. “That should indeed top the agenda for the heads of state,” Aeron Motsoaledi, South Africa’s minister of health said. Moreover, public figures and artists should support the missions through their well-crafted campaigns in such a way that Yvonne Chaka Chaka, “Princess of Africa,” did. She has impacted the community through her music and influential remarks as she translates ‘woman as a well organized ‘Man’.


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