Reducing maternal and infant mortality in Zambia

Giving birth to a baby is a joy for many women but this is not the case for many in Zambia given the high number of maternal deaths. Many women in rural areas see giving birth as not only a burden but a nightmare. Women are scared of falling pregnant due to high costs and also the shortage of midwives, which leads them to give birth at home using the services of traditional birth attendants (TBAs).

Engwase Mwale, executive director of the Non-Governmental Organizations’ Co-ordinating Council (NGOCC), has called on the government and stakeholders to treat the high levels of neonatal deaths in Zambia as a crisis.

She was commenting on UNICEF statistic that in Zambia 199 infants out of a thousand die before their fifth day. The infant mortality rate is 70 deaths per 1,000 live births and maternal mortality is 591 per 100,000 births, according the Zambia Demographic Health Survey of 2007.

Last week (12 April), Muvi TV news reported hat two women who had gone to deliver at Zambia’s University Teaching Hospital (UTH), the country’s biggest referral hospital, lost their babies due to not being attended to by midwives for four hours. The women have since engaged the Women’s Legal Aid Clinic to bring charges against the hospital.

Zambia is facing a serious shortage of midwives, doctors and nurses that will make it impossible to achieve its national and international goals including the Millennium Development Goals (MDGs) if no investment is made in health systems and services

Health systems in sub Saharan African countries face shortages of health staff, essential supplies and equipment, adequate facilities and management skills. Other problems include creating demand for available services and overcoming the stigmatization that prevents people from accessing services. The cost of health care continues to be a significant barrier to access services.

Also health systems in many sub-Saharan countries cannot deliver essential interventions well enough to reduce mortality due to challenges such as armed conflict, natural disasters, high HIV burdens and low adult female literacy rates, which when combined contribute to stagnating or deteriorating coverage.

The shortage of skilled professionals is a huge concern. In many African countries, rates of one doctor for every 10,000 people are not uncommon. Stopping the brain drain of qualified medical personnel seeking better salaries and working conditions abroad is a priority. The World Health Organization (WHO) states that sub-Saharan Africa will need an estimated one million more health workers in order to reach the health related MDGs.

One of the ways of reducing maternal and neonatal deaths is the early recognition of preventable risks as this enables families to take timely action to prevent mortality and morbidity. It is important to focus on entrenched cultural attitudes and beliefs around pregnancy and childbirth that contribute to increased risk. Few countries have community health strategies when adopting facility based approaches, which fail to take into account the factors at play in the lives of women.

Another factor is funding,which remains a challenge for both rich and poor nations. It is essential to invest in sectors that support basic healthcare, infrastructure, logistics and the referral process.

One of the biggest challenges for maternal and neonatal health is the shortage of skilled health personnel as revealed by a 2006 WHO survey. This indicates that although Africa accounts for more than 24% of the global disease burden it has only 3% of the world’s health workers and spends less than 1% of total global resources dedicated to health, even after loans and grants from abroad are taken into account.

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I am a Zambian woman working in Lusaka, Zambia under Community Initiative for TB, HIV and Malaria Plus (CITAM+). CITAM, which is a community based organisation, was set up to advocate for TB and HIV patients' rights with an emphasis on MDR TB. I am an outreach worker, working with treatment supporters who carry out the directly observed treatments shortcourse (DOTS) in communities around Lusaka and rural areas in other provinces of Zambia. I am also a board member of the African Communities Advisory Board.


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