Health

All countries in MENA are supported to ensure the right to survival, growth and development for all children

boy being examined by a doctor
UNICEF/Syria/2017/Al-Issa

Challenges

Countries in the MENA region have made tremendous progress in reduction of maternal and under-five mortality.  The maternal mortality ratio (MMR) declined by 50 per cent in the MENA region from 1990 to 2015 (from 220 to 110 maternal deaths per 100,000 live births); Under-5 mortality rates (U5MR) dropped 59 per cent in the Middle East and North Africa region from 1990 to 2015 (from 71 to 29 deaths per 1,000 live births).  Trends in neonatal mortality rate (NMR) have been similar to MMR and U5MR (49 per cent decline from 1990 to 2015) and current NMR is approximately 15 deaths per 1,000 live births in the MENA region.

Of particular note has been the unbalanced progress within countries with all segments of the population not making progress at the same rate. Higher income countries have better coverage of maternal, newborn and child survival inventions such as antenatal care visits, skilled birth attendance, protection against neonatal tetanus, and measles vaccination. Moreover the inequities and bottlenecks between countries are replicated within national borders.   

The leading causes of maternal mortality in MENA have barely shifted since 1990. Pregnancy and delivery-related complications such as hemorrhage (~20%), hypertensive disorders (~15%), maternal sepsis and other infections (~10%), obstructed labor (~10%), and abortive outcomes (~13%) endure as the major causes of maternal death. Together, these preventable causes accounted for almost 70 per cent of all maternal deaths in MENA.  Although the share of child deaths attributable to pneumonia and diarrhea has dropped since 2000, these avertible causes persist as the main reasons for post-neonatal deaths in the region.

For many years the MENA region has been plagued by ongoing conflicts, detrimentally affecting the health status of the most vulnerable population, women and children. Outbreaks of diseases have been occurring in many parts of MENA region and particularly in countries affected by conflict. Outbreak of wild polio virus in Syria and cholera in Yemen are some examples of continued public health challenges in this region. Degradation of the health system in countries in the region that are affected by conflict poses a serious challenge to the attainment of the children’s right to health.

Solution

To achieve optimal health and survival of the newborn, mother, and child, the MENA region must focus on scaling up seamless coverage of live-saving, essential interventions across the continuum of care. In addition, frameworks such as the Every Newborn Action Plan (ENAP) are being scaled up at the regional and national levels. The ENAP strategic initiative sets objectives, principles and frameworks to end preventable newborn deaths and stillbirths by 2035. By coupling global and national plans, measurement, and accountability, the aim of ENAP is to achieve equitable, high quality care for all mothers and children. Implementation of integrated approaches spread across the life cycle from pre-conception to at least two years of age is needed to strengthen the focus on post-neonatal health while battling these preventable diseases. Cost-effective, evidence-based interventions exist, which if implemented at scale and equitably, could save the majority of deaths attributed to diarrhea, and more than half of deaths from pneumonia.  Scaling up equitable coverage of immunization services in all countries and ensuring an effective vaccine management system remains a priority.

UNICEF also supports health systems strengthening (HSS) efforts with two overarching objectives: Ending preventable maternal, newborn and child deaths, and promoting the health and development of all children. Three approaches are proposed:

  1. addressing inequities in health outcomes
  2. promoting integrated, multi-sectoral policies and programmes to enhance child development and address immediate causes and underlying determinants of poor health outcomes, and
  3. HSS, including for emergency preparedness and responsiveness, and to ensure resilience.

Communities are central to successful efforts to improve health and well-being of children. UNICEF will continue to work towards ensuring that communities are empowered to take action and civil society organizations (CSOs) hold policymakers, programme managers and health professionals accountable to local needs, particularly concerning children.