A major milestone for maternal mortality

A pregnant Ms Melody Chitumba of Epworth woke up early and visited the local clinic with the intention of having a routine medical check-up.

She was subsequently referred to Harare Central Hospital (HCH) since her pregnancy was considered high risk.

Ms Chitumba suffers from pre-eclampsia.

Pre-eclampsia is a pregnancy complication characterised by high blood pressure and signs of damage to another organ system, most often the liver and kidneys.

Having followed the queue religiously, Ms Chitumba felt like she was dreaming when she was told that she no longer has to pay medical fees with effect from the beginning of 2018.

“When the clerk told me that I could keep my money, all she needed were my details so they could book me, I couldn’t believe it,” she explained.

“I then asked her to repeat what she had said earlier. I got the shock of my life today. But after recovering from the pleasant shock, I became ecstatic that I now can channel the money to buying clothes for the child I am expecting.”

Before the scrapping of user fees by Government, expectant mothers had to fork out US$50 to be attended to.

With the scrapping of user fees and slashing of prices for blood transfusions, the country is targeting a reduction in maternal deaths among other gains.

According to the Zimbabwe Demographic Health Survey (ZDHS, 2015) the country records 651 maternal mortality cases per 100 000 live births every year.

The Ministry of Health and Child Care reports that a total of 582 cases were recorded last year.

Government has slashed the price of blood in Government-run health institutions to US$50 a pint with effect from January 1, 2018.

Two months ago, Government reduced the price from US$100 to US$80 a pint at all Government institutions.

Before the reduction, a pint of blood would cost US$135 – which was beyond the reach of many.

Moreover, medical fees for infants, senior citizens and expectant/nursing mothers were scrapped on December 28, 2017 at all State-run health institutions as a measure to increase healthcare access.

Health and Child Care Ministry director for family health Dr Bernard Madzima welcomed the developments.

“The second cause of delay in causes of maternal death is when a woman has made a decision to go to a health facility but they don’t go because they don’t have money to pay at the health facility.  The latest developments will have a huge impact as the number of institutional deliveries will go up,” said Dr Madzima.

Added Dr Madzima: “Post-partum haemorrhage is the leading cause of maternal deaths, so availing blood will reduce the number of maternal deaths significantly.”

Factors associated with maternal deaths include the delay in deciding to seek medical attention, delay in reaching a health care facility and delays in receiving appropriate care.

The absence of skilled personnel during childbirth, lack of services to provide emergency obstetric care, reproductive health commodities shortages and weak referral systems also contribute to maternal mortality.

Studies have revealed that over 30 percent of mothers in the country do not deliver at health institutions and over 57 percent of mothers do not go for post natal check-up.

The major causes of maternal mortality are pregnancy-induced hypertension, post-partum haemorrhage, malaria, puerperal sepsis, obstructed labour, lack of information and unsafe cultural practices.

Although some countries in sub-Saharan Africa are experiencing a rise in the maternal mortality rate, some countries have managed to bring down the numbers.

Maternal mortality ratio for South Africa stands at 300 per 100 000 live births; Mozambique (490); Malawi (460); Tanzania (460); Zambia (440), Kenya (360); Swaziland (320); Namibia (200) and Botswana (160).

Community Working Group on Health director Mr Itai Rusike, however, feels that more still needs to be done.

“The slashing of blood price and the user fee policy of free public sector care for pregnant mothers, children under five and adults over 65 years is a welcome development that needs to be accompanied by targeted investment in supply side issues and community awareness.”

“This will increase funding to services in the lowest income areas and in community outreach to promote uptake in the lowest income groups,” said Dr Madzima.

The maternal mortality rate is the annual number of female deaths per 100 000 live births from any cause related to or caused by pregnancy or its management.

Although the country’s maternal mortality ratio dropped from over 900 deaths per every 100 000 live births to 651, the rate is still unacceptable.

“We have more to do to achieve the UN recommended figure of less than 70 maternal deaths per live births by 2030,” added Dr Madzima.

“We now need to focus on the quality of care once the women are in our institutions. We need to offer what is called ‘Respectful maternal care’.

“We are working on the availability of basic and comprehensive emergency obstetric and new-born care at the appropriate levels. Every district hospital should be able to offer Caesarean section and blood transfusion services.”

Mr Rusike maintains that although pregnant women have been getting free care at clinic level, this practice did not apply to local government and mission-run clinics.

“This needs following up with relevant ministries. There has been some shift in the region towards abolition of user fees, with evidence that this is more successful when accompanied by increased investment in primary and district level services,” added Mr Rusike.

According to the World Health Organisation, about 830 women die from pregnancy-related complications around the world each day.

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