The continuum of care
The methods for reducing maternal deaths are well established and understood. There need be no waiting for scientific advances or for more trials – it is almost as simple as recognizing that women need better health care, particularly during pregnancy, at delivery and in the post-partum period.
In countries of the region, where health systems are often weak and suffer from weak administrative, technical and logistical capacity, inadequate financial investment and lack of skilled health personnel, a continuum of care also address the gaps in care, whether in the home, community, health center, or hospital. For instance, because the majority of mothers deliver at home, it is critical that a skilled attendant be present at birth with strong backup by a local health clinic or other first-level facility.
Shortage of skilled medical personnel is a real barrier. Sub-Saharan Africa would have to increase its number of health workers by 140 per cent to reach the requisite density for skilled attendance at delivery (2.28 health care professionals per 1000 people, WHO). Yet, mid-level providers (midwives and nurses) and community health workers can broaden access to a series of essential services.
This implies, to accelerate progress, the strengthening of health systems through community involvement. As an integral part of the larger health system, community partnerships in support of maternal and child healthcare can serve a dual function: actively engaging community members as health workers and mobilizing the community in support of improved health practices, starting with stimulating behavioral change and the demand for quality health services.
Data collection and analysis needs to be improved along with the shortage of skilled workers. Financial barriers that prevent people from accessing health care need to be addressed (these include user fees, insurance and transfers) while ensuring sustainable financing for health systems and supporting infrastructure (transport, supply, logistics and referral system).
Supporting a continuum of care olso implies creating a supportive environment for maternal and newborn health based on the respect for women’s rights and the elimination of discrimination suffered by girls and women (education, protection (from early marriage, FGM/C and other violence) and participation), and fostering an atmosphere where there is a demand for quality services through health education.
If every baby’s birth, all over the world, were attended by skilled health personnel and supported by an adequately staffed and equipped referral system to manage emergencies that may arise and if there were appropriate follow-up after birth, the number of maternal deaths – little changed for decades – would tumble.
A continuum for maternal, newborn and child health