Health delivery system requires redress

09 Feb, 2014 - 08:02 0 Views
Health delivery system requires redress

The Sunday Mail

tchitsinde

The late Tendai Chitsinde

Enacy Mapakamwe
The death of popular ZTV presenter Tendai Chitsinde during childbirth last week represents the epitome of a health delivery system gone awry; one that requires urgent redress. Chitsinde died at Parirenyatwa Hospital in Harare due to pregnancy complications. The child did not make it either, in a sad case that chastises Zimbabwe’s maternal record as mortality has soared by 239 percent in the last two decades.

 

Deaths at childbirth have climbed from 283 per 100 000 live births in 1984 to 960 per 100 000 live births in 2010-2011. No matter one’s colour, tribe, profession or age, the fact is no woman should die while giving birth, or as a result of pregnancy-related difficulties.

 

It is appalling to note that in this day and age of vast improvements in medical science, Zimbabwe is still reporting escalating maternal deaths.
Such advances are generally expected to translate into improved service delivery. But the case of Chitsinde gives a different testimony.

 

Following her death, some social media networks were inundated with calls by different individuals for justice for her and many other women.
Others even advocated peaceful demonstrations against the health system to send the clear message that there is urgent need to look into the matter before many other women lose their lives.

 

It is not only Chitsinde who has lost her precious life while giving birth; there are many others who are unknown in big and smaller hospitals, private clinics and many other health facilities.

 

Her case is just a tip of the iceberg.  Chitsinde was a celebrity with access to better health facilities, which, in Zimbabwe, are found in Harare, where she resided. Despite all that, she died. What is the hope for those women in remote rural areas where the closest clinic can be 15km away and the fastest available modes of transport being scotchcarts, foot, wheelbarrows or a donkey?

 

The death of such a popular figure is an indictment on the country’s health delivery system. It puts the system into question: how much longer can Zimbabwe wait before actively implementing functional strategies to reverse the problem of high maternal deaths?

 

The situation spells doom for aspiring mothers. Losing life while giving life is the biggest irony which should be avoided at all costs.
Pregnancy is an experience women should cherish dearly despite the labour pains that come accompany it.

 

But to be pregnant in these current times is a high risk and traumatic as one is uncertain whether they will come out of a maternity ward with a baby in their arms or come out lifeless, just like the television presenter.

 

The Holy Bible says women should endure pain at childbirth, but not death. The maternal mortality rate (MMR) is the annual number of female deaths per 100 000 live births from any cause related to or caused by pregnancy or its management (excluding accidental or incidental causes).

 

This includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year.

 

According to the Zimbabwe Demographic Health Survey (ZDHS) 2010 / 2011, at least 10 women die everyday due to pregnancy-related complications, which is three times as high as the global average of 287 per 100 000 live births and almost double the average for sub-Saharan Africa with an average 500 per 100 000 live births.

 

In 2012, the World Health Organisation reported that approximately 800 women worldwide lose their lives everyday from preventable pregnancy-related complications with 99 percent of all maternal deaths recorded in developing countries.

 

More than half of these happen in sub-Saharan Africa and a third in South Asia. The major causes of MMR are pregnancy-induced hypertension, post-partum haemorrhage, puerperal sepsis, malaria, obstructed labour, lack of information and unsafe cultural practices.

 

The ZDHS reported that while there has been a decline of 34 percent in MMR from 1990 to 2008, Zimbabwe has continued to experience an increase in 1994 and 2010 / 2011.

 

According to the Zimbabwe Maternal and Prenatal Mortality Study of 2007, HIV and Aids-related conditions contribute 25 percent of total maternal deaths.

 

Yet successful prevention and treatment of all the pregnancy complications could help cut MMR by 46 percent. Poor quality care owing to different reasons among them high staff turnover and migration of skilled personnel to other countries and shortages of reproductive health commodities and decline in institutional deliveries also contributed to this gloomy picture.

 

The study also showed that about 66 percent of births are assisted by skilled professionals while 13 percent are assisted by a traditional attendant (nyamukuta) and another 13 percent by friends or relatives while the remaining three give birth unattended.

 

The Zimbabwe Agenda for Sustainable Socio-Economic Transformation (Zim Asset) which is the country’s economic blueprint, the guiding principle for policy formulation until 2018, presents hope for a better health delivery system and reduction in MMR.

 

Zim Asset sets social services and poverty eradication under one of its clusters. Under this cluster, the programme seeks to help reduce morbidity, maternal and infant mortality rates.

 

At least 90 percent of all pregnant women will be expected to receive at least four antenatal care visits while fully functional maternity waiting homes should be available in all districts by 2015.

 

Maternity waiting homes are one of the strategies Government adopted in the 1980s in the fight against MMR, especially among ruralfolk.
With many women in rural areas staying far away from clinics, the homes provide a setting for high-risk women (first time and teenage pregnancies as well as old women) who can be accommodated near a hospital in the final stages of the pregnancy, usually three weeks before their due date.

 

The ultimate goal is to contribute to a national target of reducing MMR to 174 deaths per 100 000 live births by 2015 by improving access to skilled delivery attendance by women with high-risk pregnancies.

 

Achieving this will bring relief to many — both men and women. The ultimate goal should be zero deaths at childbirth.

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