Brief Global Problem Statement Health Essay
Worldwide, maternal mortality is a public health concern not only for health sector but also for other development sectors. Low and middle-income countries are the main sufferers of this serious problem. World Health Organisation (2012) reports that 99% of the global maternal deaths occur in developing countries and most of the causes of these deaths are preventable.
According to World Health Organisation (1992), maternal mortality is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes”. Brief Global Problem Statement Health Essay.
In this essay, we will have a look in details about this issue globally then we will talk about the magnitude of this problem in Rwanda and discuss the interventions put in place to tackle it. Finally, we will identify different stakeholders who have been involved in mitigating this public health issue and discuss their assumptions and contributions towards it.
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II. BRIEF GLOBAL PROBLEM STATEMENT
Globally, statistical estimates show that the number of women dying from the causes related to pregnancy and childbirth is decreasing. According to the World Health Organisation, World Bank, United Nations Population Fund and The United Nations Children’s Fund joint report on “Trends in Maternal Mortality 1990-2010” (2012), there was a significant decrease in the total number of maternal mortality from 543 000 to 287 000 respectively from 1990 to 2010. Similarly, global maternal mortality ratio decreased from 400 deaths per 100 000 live births in 1990 to 210 in 2010 which shows an annual average decrease of 3.1%. Brief Global Problem Statement Health Essay. All low and middle-income countries experienced a decrease in maternal mortality rate from 1990 to 2010 but on different percentages.
The above progress was attributable to the international community’s effort to tackle this problem through millennium development goals initiatives that were adopted during the United Nations Summit in 2000. Millennium development goal 5 was specifically set for improving maternal health with 2 targets including reduction of three quarters, between 1990 and 2015, the maternal mortality ratio and the achievement, by 2015, of universal access to reproductive health (Mills et al., 2009).
Despite this significant progress, countries with limited resources are still experiencing a high maternal mortality rate. Mills et al. (2009) state that 1500 women daily die as a result of complications related to pregnancy and childbirth and 98 % of these deaths are reported in developing countries. Additionally, 10 to 20 million women suffer physical and mental impairment due to pregnancy and deliveries related-complications. Sub-Saharan Africa and South Asia are the known world regions which take the lead in all global maternal deaths; 50% and 35% respectively (United Nations, 2000: United Nations Millennium Declaration cited in Mills et al., 2009).
Also, high maternal mortality rates have a significant impact on socioeconomic development of these countries. Reed et al. (2000) report that death or disability of a woman during pregnancy or shortly after childbirth has not only the effect to the woman herself but also to her family in particular and to the community in general in one way or another. Brief Global Problem Statement Health Essay. Children’s health and education are affected; medical and funeral related expenditures have a great impact on household’s economic development and to the health system in general, and, to a greater extent, the country’s economic growth.
III.A.RWANDA
In Rwanda, maternal deaths caused by the pregnancy or childbirth related-complications are still high despite several initiatives put in place to tackle this public health issue. However, there has been a significant decline in maternal mortality rate compared to the previous years (Rwanda Ministry of Health, 2012).
According to Rwanda Demographic Health Surveys conducted in 2000, 2005 and 2010, there has been a steady decrease in maternal mortality rate: 1051,750 and 476 deaths per 100 000 live births respectively and the 2015 target is to reduce the maternal mortality to no more than 268 per 100 000 live births ( Rwanda Demographic Health Survey, 2010). In 2010, Rwandan woman had a risk, estimated at 1/40 (2.5%), of dying from pregnancy or childbirth-related causes during her reproductive age (Ministry of Health, 2012).
Supported by its health and development partners, the government of Rwanda has put in place various strategies aimed at improving economic development in general and maternal health in particular. These strategies were developed based on the millennium development goals and on the International Conference on Population and Development 1994 recommendations (United Nations Population Fund, 2011). Brief Global Problem Statement Health Essay. As far as maternal mortality reduction is concerned; the following strategies are in place:
III.A.1.Maternal death audit
Maternal death audit is an in-depth qualitative investigation of the causes of, and circumstances surrounding maternal deaths in health facilities (World Health Organisation, 2004). It is done by collecting information from health professionals and relatives about the events that led to the woman’s death.
The Rwanda Ministry of Health has established this surveillance system to gather in-depth information from hospitals, health centers, and the community about the women who died of pregnancy and deliveries-related complications and the gathered information helped in identification of corrective measures intended to prevent similar deaths (Rwanda Ministry of Health, 2012).
Despite its tremendous contribution in reducing maternal deaths, this health-facility and community based review of maternal deaths faces some challenges, though, due to poor documentation of cases notes in the health facilities and the information on community-related factors leading to women’s deaths in health care facilities are difficult to obtain (Kongnyuy &Van den Broek, 2008).Brief Global Problem Statement Health Essay.
III.A.2.Health system strengthening
Strengthening health system is a major component of the essential package to avert maternal deaths. To achieve this, crucial actions are needed including integration of maternal health interventions in the health system, availability of a skilled healthcare workforce, strong referral system and a strong monitoring and evaluation system to make sure that the health system responds effectively to implementation challenges and whether the interventions produce the expected results (Mills et al., 2009).
In collaboration with its health partners, the government of Rwanda has strongly strengthened the health system in terms of increasing the number of skilled health care providers and providing with them the emergency obstetrical and neonatal care trainings countrywide in order equip them with the necessary skills to deal with pregnancy and deliveries related complications. Furthermore, new infrastructures have been built and others renovated and equipped with gyneco-obstetric materials.
Maternal deaths reporting system has been improved by providing trainings to community health workers on the use of rapid short message service in reporting maternal health-related events.Brief Global Problem Statement Health Essay. They were also provided with the mobile phones to allow them to take action in real time (United Nations Populations Fund, 2012).
III.A.3.Family planning
Evidences have demonstrated that greater use of family planning services can hugely contribute to avert maternal and infant deaths in particular and to achieve millennium development goals in general ( Cates,2010).
With this in mind, the government of Rwanda has developed its policy on the promotion of family planning services as one of the strategies to attain the target(s) of millennium development goals. This family planning policy is linked to economic development and poverty reduction strategy policy as embodied in Rwandan development vision 2020 (Rwanda Ministry of Health,2006).
According to Rwanda Demographic Health Survey (2010), 52% of currently married women and 41% of sexually active unmarried women aged 15-49 are using a contraceptive method and compared to 2005 Demographic Health Survey, there has been an increase in the use family planning services. Brief Global Problem Statement Health Essay.
III.B.STAKEHOLDERS
As a low-resource country, the government of Rwanda has collaborated with several health and other development partners, either national or international, to make a significant progress, as noted in the previous sections, to avert maternal deaths. The United Nations Agencies operating in Rwanda play a key role in reducing maternal mortality. These include World Health Organisation, United Nations Population Fund, United Nations Children Fund, United Nations Development Programs…
Apart from the United Nations Agencies, several non-governmental organisations tremendously contribute to support the process of strengthening health system in terms of improving maternal health. These include IntraHealth, Partners In Health Rwanda, Global Fund to Fight HIV/AIDS Tuberculosis and Malaria, The United States Agency for International Development to mention but a few.
Moreover, local partners that are hugely involved include governmental institutions and civil society.
Each of the above stakeholders played and continues to play a key role in all initiatives to reduce the maternal mortality in order to achieve the targets of the millennium development goal 5 and 7 others. Brief Global Problem Statement Health Essay. The joint intervention of World Health Organisation, United Nations Children Fund and United Nations Population Fund has increased local and international resource mobilisation used in funding various activities aimed at improving maternal health (United Nations Population Fund, 2012). Furthermore, nongovernmental organisations supported and continue to support government efforts for safe motherhood not only in providing technical support and advocating for supportive policies but also in mobilising and donating funds.
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The involvement of governmental institutions as it is for parliament and civil society enhances the advocacy for allocation the budget, implementation of strategic policies and sensitisation and mobilisation of communities about the activities aimed at improving maternal health.
VI.CONCLUSION
Averting maternal deaths in limited-resource countries still needs a joint effort from different stakeholders. With 2 years remaining for achieving the target of reducing maternal mortality by 75% set from 1990 to 2015, some countries has made significant progress but others have still a mountain to climb (World Health Organisation,2012).
Despite this gap between countries and even within countries, World Health Organisation is committed to continuing its work on improving maternal health. As one of its key priorities, it is determined to help fill this gap by “providing evidence-based clinical and programmatic guidance, setting global standards, and providing technical support to Member States (World Health Organisation, 201. Brief Global Problem Statement Health Essay.
