Kampala, Uganda — The recently concluded 15th African Union (AU) Summit in Kampala, Uganda, deliberated on maternal, infant and child health and development in Africa. This, according to the AU Commission's Director of Social Affairs, Advocate Bience Gawanas, was a historic first for the continental body.

The health situation for pregnant and child-bearing mothers and their children is dire in Africa.

It is estimated that 12000 children die daily in Africa. Every minute, eight children die from preventable diseases or treatable conditions. Two of these children are infants.

A woman in Africa is estimated to have one out of 16 chances of dying of pregnancy-related complications or childbirth. This figure is glaring compared to the one out of 4000 risk in a developed country.

The main causes of maternal deaths on the continent are a result of haemorrhage, septic infections, hypertensive disorders, anaemia, obstructed labour, and complications of unsafe abortions and increasingly HIV/AIDS complications in expectant mothers.

These are compounded by inadequate food security and malnutrition, tuberculosis, malaria and other communicable and non-communicable diseases, as well as neglected tropical diseases.

At institutional level - that is at health facilities - it was found that the absence of skilled health personnel at birth is the strongest contributing factor to maternal deaths.

In five most affected African countries, only 18 to 47 percent of births had skilled attendants present. This is compared to 79 to 99 percent in least affected countries.

Access to reproductive and sexual health advice and commodities is vital to progress, said the Africa Public Health Information Service.

It stated that in five most affected countries, a mere 2.8 to 14.6 percent of couples have reported the use of family planning. In the five least affected countries, 55.1 to 75.8 percent of couples have gone through family planning.

As far as child mortality goes, 167 to 220 deaths per 1000 live births occur in countries with the highest maternal mortality.

HIV/AIDS is a growing threat to mother and child health and welfare in 36 out of 54 countries, where 58 to 65 percent of HIV-positive adults are women.

The information ser-vice stated that overall progress remains minimal. The average maternal mortality across Africa for the last five years was about 260000 per year, claiming the lives of about two million African women since the Millennium Development Goals were adopted in 2000.

According to the AU Commission's Department of Social Affairs, this critical situation is as a result of weak health systems in African states, delays at different levels in assessing health services and lack of emergency neonatal obstetric care and family services.

There is no quick fix, suggested the African Public Health Information Service, that said that the poor ratio of health workforce to population means most countries will need to double, triple or even quadruple the health workforce to make long-term and sustainable progress to maternal health and other health needs.

Equally, it said, there is a need for rapid changes in long-term, education and labour practices, including integration with health planning.

"The statistics do not augur well for Africa," commented the AU Commission's Director of Social Affairs, Adv. Bience Gawanas.

This AU Summit's theme was maternal, infant and child health and development in Africa. And in response to the dire trend, the Summit adopted the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA).

So far, 16 of the AU Member States - including Namibia - have launched CARMMA. AU Commission Chairperson, Jean Ping, said the plan is that an additional seven countries will adopt CARMMA by the end of the year.

CARMMA is derived from key priority areas enshrined in the 2005 AU Policy Framework for the Promotion of Sexual and Reproductive Health and Rights in Africa and the Maputo Plan of Action in 2006.

The 2005 framework calls for mainstreaming of sexual and reproductive health and rights in primary healthcare to accelerate the achievement of health-related Millennium Development Goals (MDGs), and in particular the fourth, fifth and sixth MDGs.

MDG 4 deals with promises made to reduce the under-five mortality rate; MDG 5 calls for the reduction of maternal deaths by three-quarters; and MDG 6 calls for the halt and reverse of the spread of HIV/AIDS, for the achievement of universal access to treatment for HIV/AIDS by this year [2010], and the halt of the incidence of malaria and other major diseases.

The AU Department of Social Affairs said 10 African countries are on track with MDG 4. Algeria, Cape Verde, Egypt, Eritrea, Libya, Mauritius, Morocco, Seychelles, Tunisia, and recently Malawi, have made strides. Others that have made some progress are Ethiopia, Tanzania and Ghana.

With respect to MDG 5, most countries could not give dependable statistics, but 40 are estimated to have very high maternal mortalities.

Countries that have made progress on this score are Benin, Burkina Faso and Ghana.

On the other hand, one of the main pillars of the Maputo Plan of Action is the prevention of maternal and child morbidity and mortality. It calls for a redoubling of efforts to attain universal access to sexual and reproductive health in all African countries by 2015.

This is considered as one of the most robust collective responses to the alarming rate of deaths among women and children in Africa - a sensitive indicator of the inequality between men and women on the continent.

CARMMA focuses on three key areas: positive messaging, encouraging the achievement and strides made by countries to reduce maternal mortality and seeking to replicate them, and to intensify actions aimed at reducing maternal and infant mortality.

Important at this summit, said Gawanas, was that under the CARMMA programme, Heads of State committed themselves to key actions - and not a declaration likely to gather dust.

"This is a historic first in the sense that the debate [of the summit] focused on the lives of women and children on the continent," said Gawanas, who added that she has no doubt that Africa's leaders have shown the political will to promote the health and well-being of wo-men and children.

These actions include the launch of CARMMA with the hope that its mandate would be broadened and the strengthe-ning of a comprehensive and integrated health system across Africa. Gawanas said national activities fall under the stewardship of national governments.

The action steps include the scaling up of good practices; sustainable financing to start with domestic resource mobilisation with a look at public-private partnerships and other possibilities, such as the waiving of user fees and the introduction of national health insurance; mechanisms to be pursued by the AU to see how member states can access pledges for funding from the G8 and Global Fund; a call to global partners to replenish the Global Fund; and a commitment to a functional and strong monitoring and evaluation system for accurate and timely information on the situation.

There was also a commitment that maternal, infant and child health matters will feature permanently on the yearly agenda of the AU Assembly, which is the highest decision-making body of the AU.

Civil society groups that were at the summit, felt that the outcome on the theme was positive, but expressed reservations over how fast and steadily African states will respond to the commitments.

Before the key activities were adopted, at least 117 civil society organisations expressed concern that some Heads of State have been advised to repudiate crucial commitments on health and social development.

One particular commitment by Heads of State is contained in the 2001 Abuja Declaration - that every African government will commit at least 15 percent of the national budget to the health sector.

According to the WTO's World Health Statistics for 2010, only three countries' health budgets exceeded the 15 percent mark.

These are Rwanda (19.5 percent), Tanzania (18.4 percent), and Liberia (16.6 percent). Namibia's health budget constituted 11.1 percent of the national budget.

The civil society organisations complained that at present, 34 African countries are investing less than the WTO recommended minimum package of US$40 per capita on health.

These include 27 African countries investing less than US$20 per capita on health and 15 countries investing as little as US$2 to US$10 per capita on health.

"Clearly per capita investment in health needs to improve alongside percentage allocation for Africa and its citizens to have a chance to fulfil potential and aspirations," the organisations said.

Executive Director of the International Community of Women Living with AIDS East Africa, Lilian Mworeko, felt not enough emphasis was put on HIV/AIDS, which shows a clear linkage between the di-sease and maternal and child deaths.

"It is naïve of presidents and governments not to mention HIV," said Mworeko, adding that it was equally disappointing that African leaders did not address the criminalisation of HIV that is increasingly seen across the continent.

Uganda, for example, is considering a draft Bill to criminalise the spread of HIV, and includes provisions for forced disclosure of HIV status, as well as mandatory testing.

Gawanas felt that mention of HIV/AIDS would be superfluous.

"The intention was not to make the key action points disease- specific; we know the causes of maternal and child mortality. We must move away from vertical approaches and look at the totality. We want an integrated approach," countered Gawanas.

Africa Advocacy Advisor of Save the Children, Chikezie Anyanwu, was more upbeat in his comments on the commitments made by the summit.

"The maternal and child health principles African leaders have committed to are excellent. Now they must follow through. If they dedicate the resources promised and employ the strategies outlined here, African leaders could save the lives of millions of children and mothers and dramatically boost the development of their nations and the continent. We are prepared to work with the leaders to make their decisions a reality for African people," said Anyanwu.

Save the Children also commended African leaders for pledging to reduce out-of-pocket health expenses through initiatives like waiving fees for pregnant women and children under the age of five years.

"Most importantly of all," said Anyanwu, "African leaders have acknowledged what is in fact the silver bullet needed to end maternal and child deaths - political will.

"The solutions to ending these preventable deaths annually are well known. If the leaders exercise the will to take concrete actions as they have said here [at Kampala], there is no reason Africa cannot save the lives of millions of its mothers, new-borns and children."