Improvement of maternal and child health as a global issue has not been very regular. Several programs and research projects in various countries have lately been focusing on the root causes of the issue and how health systems can provide better public health services and better quality of care for women and children.
In 2010 United Nations estimated, some
800 women died every day from complications of pregnancy or childbirth, 99% of
them in developing countries. Some 7.6 million children died before the age of
five. While these numbers were high, they reflected considerable gains for
maternal and child health since countries agreed in the year 2000 to a set of
ambitious development targets.
A deeper look exposes that these gains
are socially irregular. Maternal mortality is higher in rural areas and among
poorer & marginalized communities in developing countries. Deaths in
children under five are increasingly concentrated in South Asia, South Eastern Asia
and in sub-Saharan Africa. In two-thirds of countries that have made progress
on child mortality, the gap between rich and poor actually increased. This again
reveals the fact that improved health services and good quality health care are
not reaching those who need them most.
In many regions, the inadequate care
women receive branch from their low social status. From childhood onwards girls
have less access to education and poorer nutrition. As they grow older, they
are mostly excluded from economic and political participation, and suffer
domestic violence. Very often, women are the last to eat, and the last to
receive medical treatment.
Identifying root causes & systemic factors of poor maternal and child health care
Through our studies we get a unique
perspective to maternal and child health in marginalized communities and in
low-income groups in rural Bihar, India. Going beyond a routine focus on
maternal and child health, we decided promoting initiatives that hit some
systemic factors (Health services, Quality of service & Service delivery) undermining
women's and children's health and to strategically improve quality of the
mentioned factors.
This approach of combating poor quality
of service ensures to work closely with the service providers to strengthen the
health systems for better service delivery for maternal and child health. We
decided to focus on individual capacities and provide strategic technical
assistance that improve quality of care and a health system responsive to
maternal & child health.
Our research findings responded to a
more nuanced challenge: What are the health priorities this system (in Rural
Bihar) must respond to, and how can it do so effectively and sustainably?
Strengthening
Capacity of service providers to improve maternal and child health care in
Bihar, India:
With one of the highest infant, child,
and maternal death rates in the world, Bihar, India is yet to put primary
health care at the top of its priorities. In 2010, the Government of Bihar, and
Bill and Melinda Gates Foundation (BMGF) formed a partnership to support health
care reform by system strengthening. Following extensive consultations and
assessments, the Manav Vikas Mission, Bihar was launched with a re-focus (among
several other development issues) on strengthening public health systems and to
build capacity of the maternal health service providers in Bihar. The
innovation we came up with was a new method of strategic mentoring
of the nurses working in the public health system.
This aims to improve the Quality of Care and FP services. This
mentoring program has been piloted in 80 Public Health facilities of eight
districts of Bihar and the experiences of the pilot phase have been used to replicate
and scaling up.
Better skills lead to early
identification of complications and their competent management result in lesser
maternal and newborn deaths, reduced costs of poor and marginalized patients
and most importantly, an overall increase in the confidence of pregnant women
to avail the public health services.
All of this has been possible as we could
improve skills of the service providers; use proven protocols for identifying
and managing complications. The mentoring program (AMANAT) was designed to help
to achieve this goal in the public health facilities of Bihar.
In most of the project areas, evidence
suggests that the mentored nurses are taking better care of the pregnant women
in the facilities and we have also found that the emergency response level of
the mentored nurses have gone several levels higher. And we have been lucky to
find positive and long lasting changes taking place.
Authors: Victor Ghoshe
State Resource Unit, Bihar, India
Victor
Ghoshe is the Lead - Communications, Bihar Technical Support Unit
Reference: Some figures are taken form
documents developed by Canada's International Development Research Centre
(IDRC).
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