Binyam Tamene
5 July 2009
Addis Abeba — If African countries have to meet MDG 5, according UNFPA, innovative approaches to human resource planning and quality service provision that are required to avert maternal death are needed.
One such approach is the development and deployment of non-physician clinicians (NPCs), cadres of health professionals who are not doctors but who provide significant clinical care even in the most remote areas, the UN agency said.
Ethiopia's Minister of Health, Dr. Tewodros Adhanom, also emphasized the need to dramatically expand and strengthen Africa's health workforce so as to improve the survival and health of mothers and children.
"(We have to) go beyond re-affirming our collective resolve to act on the crisis and craft and refine more informed policies and strategies that would improve the health of mothers and their chances of survival during pregnancy and childbirth," the minister said, speaking at a conference focused on seeking strategies for developing and deploying non-physician clinicians (NPCs) as an important means of reducing maternal death and disability in Africa.
Within the Call to Action, the development and deployment of NPCs was acknowledged as an important and innovative solution to this human resource crisis.
Currently, more than 50% of African countries have programmes that train non-physicians in integrated emergency obstetric surgery and Ethiopia has joined that league. The experiences in four African countries with such programmes - Mozambique, Malawi, Tanzania, and Zambia - shows that the retention rate of these mid-level professionals has been much better than rates for professional doctors, with less cost of training, deployment, and remuneration.
In most of Africa, there are fewer than five doctors for every 100,000 people, and each year, 20,000 health professionals leave their posts to pursue jobs in urban areas or outside their own countries.
As a result, there is a huge inequality in access to Emergency Obstetric Care (EmOC) services between rural/urban and rich/poor, making the rate of maternal death high in most parts of Africa.
The Caesarean section rate according to the Ethiopian Demographic and Health Survey (EDHS) 2005, for instance, is only 1% with almost all being done in urban areas. Only 6% of births occur in a health facility attended by skilled health personnel, the survay indicated.
It is not surprising, therefore, that 25,000 women die each year in Ethiopia as a result of obstetric complications, most of them occurring among the rural poor, making attainning MDG 5(ensuring universal access to reproductive health by 2015) unsuccessful.
In a keynote address to the conference, Prof. Lynn Friedman, Director of the Averting Maternal Death and Disability programme (AMDD) of the Mailman School of Health in Columbia University, described maternal health problems as a fundamental human rights issue.
"We need to see health problems and health systems through the eyes and the experience of the people who suffer those problems and who make up the systems." At the end of the conference, African Ministers of Health and delegates from 42 countries, including 29 African nations, have endorsed a Call for Action that would improve the health of women and children worldwide.
This Call for Action focuses on task-shifting emergency obstetric care (EmOC) from surgeons to highly trained non-physician clinicians (NPCs) in order to address the critical human resource gap and prevent needless death and disability during pregnancy and childbirth.
During the four-day meeting here in Addis Ababa, more than 350 participants comprising senior government officials, health programme managers, clinicians, and heads of health training institutes noted that continued poor access to reproductive health care, including family planning, and to quality care during pregnancy, childbirth and the postpartum period, are responsible for the deaths of half a million women and over a million newborns and children every year.
Endorsing the Call to Action, delegates committed to ensuring that national human resource plans address the critical shortage of trained health professionals and the specific skills required to save mothers and newborns.
They also pledged that these plans be fully developed, adequately financed, and implemented so as to ensure quality training, distribution, motivation and retention of health workers.
Minister Tewodros urged his colleagues from the continent to be creative in seeking solutions to the tragedy of maternal mortality and morbidity in Africa.
"Let us train more health workers and introduce financial and non-financial incentives to retain them, as part of a comprehensive strategy that addresses the health system in each country," he advised.
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