Mithre J. Sandrasagra
UNITED NATIONS, Apr 7 2006 (IPS) – The current crisis of skilled healthcare workers could deal a fatal blow to the global anti- poverty campaign agreed to by world leaders six years ago, U.N. experts warned on World Health Day.
The global population is growing, but the number of health workers in many of the poorest countries is falling, U.N. Secretary-General Kofi Annan noted Friday.
Access to services is limited by inequity and poverty, Arletty Pinel, chief of the Reproductive Health Branch of the U.N. Population Fund (UNFPA), told IPS.
According to U.N. estimates, Africa alone will require a million new health workers to achieve the Millennium Development Goals (MDGs), a global plan of action aimed at reducing poverty by half and radically improving the lives of at least one billion people by the year 2015.
Currently, there are no countries in Africa, Asia, or Latin America and the Caribbean that are on pace to meet the target of reducing maternal mortality by three-quarters by 2015, according to the Statistics Division of the U.N. Department of Economic and Social Affairs.
Addressing the shortage of midwives through education, training and deployment to underserved areas would bring us much closer to achieving the MDG of improving maternal health, said Thoraya Ahmed Obaid, executive director of UNFPA.
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Concerted efforts are urgently needed to solve the shortage of midwives and other health workers a shortage that is severe in the poorest countries, putting the lives of millions of people at risk, said Obaid.
Midwives play a central role in saving the lives and improving the health of mothers and infants around the world. Yet despite their importance, they often face poor working conditions, inadequate supplies and support and, as a female health workforce, are subject to gender discrimination, she continued.
Addressing the shortage of midwives could also bring countries closer to achieving another MDG, which is to reduce child mortality by two-thirds by 2015.
Some 700,000 more midwives are needed to provide universal access to skilled care at birth, according to UNFPA.
Contrary to child survival that has shown dramatic increases over the years, maternal deaths continue to maintain themselves at about the same level and in some countries have increased, Pinel said.
The chance that a woman will die due to pregnancy-related causes is one in 17 in least developed countries, one in 61 in developing countries, and one in 4,000 in industrialised countries, according to Family Care International (FCI), a New York-based NGO endorsed by the U.N.
The single most critical intervention for safe motherhood is to ensure that a health worker with midwifery skills is present at every birth, and transportation is available to a more comprehensive level of obstetric care in case of an emergency, according to UNFPA.
In the developing world today, only 58 percent of all deliveries take place with the assistance of a trained attendant.
Professional accredited midwives have successfully passed a relevant midwifery programme that is approved in the country where they practice. In some countries this may entail up to five years of university-level training, Pinel said.
In 76 countries, UNFPA supports training of health personnel in various aspects of maternal care, including life-saving skills for emergency cases.
Many expectant mothers, especially in Africa, deliver with the help of traditional birth attendants (TBAs). This practice has proved dangerous, according to FCI, because up to 15 percent of all births are complicated by a potentially fatal condition that TBAs are unqualified to handle.
Women attended by trained attendants are more likely to receive treatment early, when the situation can still be controlled.
In the majority of cases, maternal mortality reductions have been achieved where countries have introduced professional midwives, while at the same time phasing out TBAs without criminalising them, according to Pinel.
For example, Malaysia used media campaigns to persuade women to use midwives, but they also offered mechanisms where TBAs would partner with midwives.
Making TBAs partners with professional midwives has been applied in a number of countries including Bangladesh, Indonesia, Iran, Mexico, Nigeria and Uganda, according to Pinel.
In Yemen, there are eight maternal deaths daily one of the highest rates in the world. Seventy-five percent of Yemenis reside in villages in mostly isolated regions, whether in the mountains or the desert. Home deliveries in Yemen are estimated at 84 percent.
We found that the main reasons for maternal mortality are the difficult circumstances women live under in these regions, said Asia Makwi, the project s programme officer.
Last year, UNFPA began a project in collaboration with the Yemeni Social Affairs and Labour Ministry to provide midwives with the tools they require to deliver babies safely, and distribute safe childbirth kits . The kits consist of sterilised masks and gloves, soap for washing hands, pieces of plastic cloth and sterilised cotton, sterilised thread and razors, and a brochure from which midwives in any region can learn delivery procedures.
Countries that invest in high-quality training, placement and retention of midwives, while at the same time investing in facilities to provide emergency obstetric care, will show dramatic improvement of maternal mortality, according to Pinel.
The time for action is now, said Kathlyn Ababio, the International Confereration of Midwives (ICM) representative here during the World Summit at the end of 2005, when world leaders reaffirmed their commitments to the MDGs.
In Africa and Asia, only between a quarter and a third of women deliver with a skilled attendant, and even fewer have access to emergency obstetric and neonatal care. This must change, and soon, stressed Ababio.
ICM is a non-governmental organisation (NGO) that unites 85 national midwives associations from over 75 countries.
In sub-Saharan Africa, there are an estimated 750,000 health workers in a region that is home to 682 million people. By comparison, the ratio is 10 to 15 times higher in wealthy countries, according to Dr. Tim Evans, assistant director-general of Evidence and Information for Policy at the World Health Organisation (WHO).
Without a dramatic increase in capacity, paediatric immunisations will not be administered; infectious outbreaks will not be contained; curable diseases will remain untreated; and women will keep dying needlessly in childbirth, Annan said.
Dead mothers don t talk, and those that surround them sometimes see this as a normal process of life. But most maternal deaths could have been avoided if the system hadn t failed those women, according to Pinel.
The persistence of maternal mortality and morbidity, when the interventions to prevent them are well understood, represents a human rights violation and social injustice, she emphasised.
