SA faring badly on baby deaths

Infant Set MATERNAL, newborn and child deaths would be drastically cut ifSouth Africa simply implemented the policies it already has inplace. The country is one of only 12 countries globally that hasincreasing rates of child deaths. Yet it is estimated that over 40200 child deaths, as well as many maternal deaths and stillbirths,could be avoided with simple, internationally recognisedinterventions. At least 260 mothers, babies and children die daily. Dr Joy Lawn of Save the Children said South Africa has thepotential to significantly reduce the increasing deaths by ensuringthat policies such as those for the programme for the prevention ofmother-to-child transmission are implemented properly. Much poorer countries, such as Malawi, Rwanda and Tanzania, havemade good progress in cutting maternal, newborn and child deaths byfirst admitting there was a problem, then using available expertiseto formulate interventions to impact the death rate. The Countdown 2008 report, released recently, showed that SouthAfrica was failing its mothers and children, with almost 2 000mothers and 75 000 children under five losing their lives everyyear. HIV was highlighted as a major challenge in South Africa,given that HIV rates are up to ten times higher than in otherAfrican countries. Health Minister Manto Tshabalala- Msimang has questioned thereport’s findings and dismissed the experts’ findingsas flawed. In response, The Lancet journal said Tshabalala-Msimang’sattempts to divert attention to the fact that developed countieswere recruiting Africa’s healthworkers, the very people whoshe said would have provided care for the mothers and children, wasflawed, as South Africa has twice the Countdown benchmark for suchpersonnel. “What she failed to do was openly concede failures, addressthe concerns set out in the Countdown report, and look for ways toimprove health care for women and children. There were few signs ofcommitment to take action, other than to mention a need tostrengthen health systems. Some countriesthat had similar child mortality rates and similar gross nationalincomes to South Africa in 1990, such as Brazil, Mexico and Egypt,are now on track to meet Millennium Development Goal for childsurvival, having halved their under-five mortality rate in those 18years. South Africa’s current policy is that a postnatal visitshould happen within seven days, but no data is available as towhether this happens or not, and there is no current provision forroutine home visits. In any case, research shows that threequarters of maternal and baby deaths have already occurred by dayseven after birth, so the first few days are crucial. In facilities, audit systems to track deaths of mothers, babies andchildren have been used widely in South Africa to improve thequality of care, but staff shortages, low morale and securityissues have limited the capacity of staff to make changes, and haveencouraged many to seek work in the private sector or out of thecountry. Lawn said that South Africa could look at its human resourcepolicies so that the most life-saving care reaches people in ruraland hard to serve areas. “There needs to be more delegationof tasks – problems need to be solved within the context ofhuman resources,” she said, explaining that many tasks maynot need a doctor . “There is, for example, no reason whymiddle-grade staff cannot do blood tests, which will free upmidwives to do the work that is lifesaving. In Mozambique, Malawiand Tanzania, the majority of obstetric procedures, includingcaesarean sections, are done by non-physicians, includingmidwives.” Lawn points out that, compared to the rest of Africa, South Africahas fantastic facilities, more skilled staff and no user fees.“Theoretically, all the ingredients are in place, but we needto consider this as the critical time to act and put these do-ablemeasures in place fast.”