South Sudan faces challenges providing maternal and child health care
By Kun Li
TORIT, South Sudan, 13 April 2012 – It was a busy morning in the maternity ward of Torit Civil Hospital, Eastern Equatoria State.
Three newborns were welcomed into the world, all in good health. Surrounded by family members, Lugina Michael let out a sigh of relief.
“I spent five days at home in pain,” she said, recalling her difficult labour. “Then we finally got a car and I was brought here the same day. When I arrived, I didn’t know what time it was, and what was happening to me.”
Lack of transport
Ms. Michael comes from a mountainous region some 80 kilometres away from Torit, the state capital. The area is accessible only by dirt road, making it difficult for poor families like Ms. Michael’s to travel to the outside world. When she finally got to the hospital, she was in such a bad state that all the midwives believed that would have to undergo a Caesarean section.
“The biggest problem for women in labour is the lack of transport,” said Estrina Zacharia, a midwife who has been working in the hospital for over 16 years. “For those who live far, by the time they are brought to the hospital, they are already very weak. Sometimes the child is dead in the womb, or we deliver the baby alive but the mother is very weak.”
But Ms. Michael came to the right place. Unlike other health facilities in the region, Torit Civil Hospital has a dedicated mother and child health wing, which offers integrated services including antenatal care, immunization, HIV testing and counselling, and services to prevent the mother-to-child transmission of HIV. Its maternity ward is among the better ones in the state, with experienced personnel like Ms. Zacharia. UNICEF supports the hospital with midwife trainings, assistance constructing new wards, and provision of essential supplies such as vaccines.
But more remains to be done.
Emerging from a two-decade civil war, the world’s youngest nation faces many challenges in providing health care to its population, particularly maternal and newborn health care. Only 19 percent of births are attended by a skilled health worker. And there are broad disparities in healthcare access, with children and women in rural areas having far less access to care than those in urban areas.
Irene Lubambula, a nurse from Uganda, has been working at Torit Civil Hospital’s antenatal clinic for the past two years. “Many women don’t attend their scheduled visits,” she said. “For those who do, they don’t always come regularly or disappear entirely, and give birth at home in their villages. It can be a problem if complications arise.” Compounded by poor infrastructure and weak capacity, the country also has a serious shortage of trained health workers.
“Maternal mortality in South Sudan is one of the highest in the world,” said Romanus Mkerenga, UNICEF Chief of Health and Nutrition in South Sudan. “Sixteen mothers die every day from pregnancy-related complications. All of these deaths could have been prevented if they had access to skilled attendants at delivery.”
Painstaking but critical progress
Working with partners, UNICEF supports the Government’s efforts to make outreach services available to expectant mothers living in rural areas. UNICEF provides training for traditional birth attendants, as well as medical and transportation equipment for healthcare providers, including motorcycle ambulances for the local health posts. Although the picture remains bleak, notable progress has been made in recent years.
“We have seen the number of antenatal clinics on the rise throughout the country,” said Dr. Mkerenga. “The quality of health workers is improving, as well as provision of supplies, medicines, and awareness of mothers on coming to the services on time, and as frequently as required.”
Bringing basic health care to the people, especially those in rural areas, is the only way to overcome South Sudan’s high maternal mortality rate. It will be a painstaking process, but a critical one, as the new nation’s future depends on the health and survival of its women and their children.
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