m aternal s urvival and h ealth a p athway to d evelopment in u ganda
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M aternal S urvival and H ealth A P athway to D evelopment in U ganda. Application of the REDUCE Model in Uganda. Uganda: Sustained Economic Growth. US$. 186. Annual per Capita Income. $. $. Uganda: Sustained Economic Growth. US$. 330. 186. Annual per Capita Income. - PowerPoint PPT PresentationTRANSCRIPT
MMaternal aternal SSurvival urvival
and and HHealthealth
A Pathway to
Development in Uganda
Application of the REDUCE Model in Uganda
Uganda: Sustained Economic Growth
Annual per Capita Income
US$
186
Uganda: Sustained Economic Growth
Annual per Capita Income
US$
186
330
$
$
Uganda: An Inspirational African Success Story
Uganda: An Inspirational African Success Story?
• Total fertility rate (TFR) 6.9
• Infant mortality rate (IMR) 97• Child mortality rate (CMR) 147
• Child stunting at 2 years of age 45%• Full vaccination at 2 years of age 44%• Access to safe water in rural areas 47%• Primary education completion 34%
HDI: HDI:
158/174
158/174
Maternal Death
“The death of a woman during
pregnancy, delivery, or the
six weeks following the birth
of her baby.”
(WHO, 1980)
UN
ICE
F/C
-55
-10
/Wa
tso
n
Maternal Mortality Ratios in Africa
1200
506
280250230
0
200
400
600
800
1000
1200
South Africa Botswana Zimbabwe Uganda UN UgandaEstimate
Source: UNFPA, 1999
Maternal Deaths/100,000 Live Births
Maternal Mortality Ratios in Africa
1200
506
280250230
0
200
400
600
800
1000
1200
South Africa Botswana Zimbabwe Uganda UN UgandaEstimate
Source: UNFPA, 1999
Maternal Deaths/100,000 Live Births
Mothers’ Index
The Mothers’
Index ranks
Uganda 76
out of 106
countries
UNIC
EF/P
irozz
i
Source: Save the Children, 1999
Maternal Mortality
Maternal Mortality: a Small Part of a Larger Problem
Poor Healthand
Disability
UN
ICE
F/C
-79-
53/G
oods
mith
Women’s Participation in the Labor ForceU
NIC
EF
/C-7
9-53
/Goo
dsm
ith
Women’s economic contribution is crucial to reduce poverty
(Ugandan Labor Survey, 1998)
53%
Population Living in Absolute Poverty
Poor maternal health reduces
dramatically the capacity of
Ugandan women to grow out of
poverty
44%
(Source: UNICEF, 1999)
Investing in Safe Motherhood in Uganda
Increases Survival
Improves Health
Reduces Poverty
Major Causes of Maternal Mortality in Uganda
HIV/AIDSHIV/AIDSMalariaMalaria
AnaemiaAnaemia
Women’s Low Status
Lack of access to
and control of
resources
Limited access to
education
Lack of decision-
making power
Jorg
e M
ore
iro
Inadequate Attention to Adolescent Reproductive Health
70%
Percentage of
Ugandan women
who experience
their first pregnancy
by the age of 19
REDUCE… a Model on
Maternal Health and Survival
Reduce Model
Data on Maternal Health
Estimating the Consequences of Poor Maternal Health
Impact on Survival and Productivity (2001-2010)
REDUCE: Data Used
Uganda 1995 Demographic and Health Survey
WHO Global Burden of Disease
Uganda Safe Motherhood Costing Study
1991 Demographic Projections
Sexual and Reproductive Health Minimum Package
Other local literature and surveys
Survival
Maternal Deaths (2001-2010)
61,000 Maternal Deaths!
Jorg
e M
ore
iro
Infant Deaths per 1000 Life Births (Bangladesh)
Infant Deaths/1000 Life Births
Infant Deaths Resulting from Maternal Deaths
40,000 Infant DeathsJorg
e M
ore
iro
65%
Infant Deaths Resulting from Maternal Poor Health During Pregnancy
65%
Neonatal Tetanus: 38,000 Infant Deaths
Maternal Iodine Deficiency: 31,000 Infant Deaths
Maternal Malaria and Anemia: 220,000 Infant Deaths
Maternal Deaths (2001-2010)
61,000 Maternal Deaths!
Jorg
e M
ore
iro
Older Children
Orphaned Children
More
vulnerable
to
rights
violations
Disabilities
1 Woman Dies
Maternal Mortality: a Small Part of a Larger Problem
20-30 Women Suffer Short and Long Term Disabilities
Maternal Mortality: a Small Part of a Larger Problem
110,000 women will become infertile 1,200,000 women will suffer:
Inability to breastfeed Anaemia Incontinence due to fistulae Chronic pelvic pain Emotional depression Physical weakness Reduced productivity
(2001-2010)
Economic Consequences
Present Value of Productivity Losses
47353400 million US $
(2001-2010)
Iodine Deficiency during PregnancyU
NIC
EF
/C-7
9-39
Iodine is necessary for the normal development of the baby’s brain during pregnancy
Iodine Deficiency during PregnancyU
NIC
EF
/C-5
6-19
/Mur
ray-
Lee
Translates into reduced
Learning ability
School performance
Retention rates
in School-Age Children
Permane
Permane
nt!nt!
Present Value of Productivity Losses
47353400
million US $
(2001-2010)
408808
Recommendations
Three Delays
Delay in deciding to
seek appropriate care
Delay in reaching a
treatment facility
Delay in receiving
adequate treatment
at the facility
UNICEF/C-55-10/Watson
Maternal Mortality Ratios in Africa
1200
506
280250230
0
200
400
600
800
1000
1200
South Africa Botswana Zimbabwe Uganda UN UgandaEstimate
Source: UNFPA, 1999
Maternal Deaths/100,000 Life Births
Maternal Mortality Ratios in Africa
792
334280250230
0
200
400
600
800
1000
1200
South Africa Botswana Zimbabwe Uganda UN UgandaEstimate
Source: UNFPA, 1999
Maternal Deaths/100,000 Life Births
The Six Pillars of Safe Motherhood in Uganda
Safe MotherhoodSafe Motherhood
Fam
ily P
lann
ing
A
nte-
Nata
l Car
e
O
bste
tric
Care
P
ost-N
atal
Car
e
P
ost-A
borti
on C
are
S
TD-H
IV C
ontro
l
1. Family Planning
Increase number service delivery points
Encourage adolescents to delay first pregnancy
Encourage couples to space births
Update service providers’ skills:
Contraceptive technology
Counseling
2. Ante-Natal Care
Provide iron+folic acid supplements
Conduct immunization against tetanus
Conduct routine deworming
Provide presumptive treatment for malaria
Screen for risk factors
3. Skilled Obstetric Care at Birth
Increase the number of midwives
Update providers’ life saving skills
Monitor labor using a partograph
Provide essential obstetric care
Improve referral system
Mobilize ambulance/transportation services
Provide vitamin A supplement after delivery
4. Post-Natal Care
Identify and manage danger signs
Counsel and provide family planning services
Counsel on maternal nutrition during lactation
Promote good traditional social support
Conduct maternal mortality audits and review meetings
5. Post-Abortion Care
Train and equip personnel to offer MVA
Counsel and provide family planning services
Start prompt treatment for sepsis
6. STD/HIV Control
Offer voluntary testing and counseling
Screen pregnant women for syphilis
Manage cases and their complications
Continue and expand ongoing successful
prevention activities
The Six Pillars of Safe Motherhood in Uganda
Safe MotherhoodSafe Motherhood
Fam
ily P
lann
ing
A
nte-
Nata
l Car
e
O
bste
tric
Care
P
ost-N
atal
Car
e
P
ost-A
borti
on C
are
S
TD-H
IV C
ontro
l
The Six Pillars of Safe Motherhood in Uganda
Safe MotherhoodSafe Motherhood
Fam
ily P
lann
ing
A
nte-
Nata
l Car
e
O
bste
tric
Care
P
ost-N
atal
Car
e
P
ost-A
borti
on C
are
S
TD-H
IV C
ontro
l
Communication for Behavior Change
The Six Pillars of Safe Motherhood in Uganda
P r i m a r y H e a l t h C a r eP r i m a r y H e a l t h C a r e
Safe MotherhoodSafe Motherhood
Fam
ily P
lann
ing
A
nte-
Nata
l Car
e
O
bste
tric
Care
P
ost-N
atal
Car
e
P
ost-A
borti
on C
are
S
TD-H
IV C
ontro
l
Communication for Behavior Change
The Six Pillars of Safe Motherhood in Uganda
E q u i t y a n d E d u c a t i o n f o r W o m e nE q u i t y a n d E d u c a t i o n f o r W o m e n
P r i m a r y H e a l t h C a r eP r i m a r y H e a l t h C a r e
Safe MotherhoodSafe Motherhood
Fam
ily P
lann
ing
A
nte-
Nata
l Car
e
O
bste
tric
Care
P
ost-N
atal
Car
e
P
ost-A
borti
on C
are
S
TD-H
IV C
ontro
l
Communication for Behavior Change
Benefits of Action
Maternal Mortality Ratios in Africa
1200
506
280250230
0
200
400
600
800
1000
1200
South Africa Botswana Zimbabwe Uganda UN UgandaEstimate
Source: UNFPA, 1999
Maternal Deaths/100,000 Life Births
Maternal Mortality Ratios in Africa
792
334280250230
0
200
400
600
800
1000
1200
South Africa Botswana Zimbabwe Uganda UN UgandaEstimate
Source: UNFPA, 1999
Maternal Deaths/100,000 Life Births
Program Implementation 2001-2010
Percentage Reduction in MMR
Year of Implementation
Benefits of Action
Estimated for: Better ante-natal care Better obstetric care Reduction of:
Malaria Anaemia Iodine deficiency
Not Estimated for: Better neonatal care Better family planning Reduced incidence of STDs/HIV
Lives Saved and Disabilities Averted
12,500 lives of women
60,000 lives of children253,000 women spared from
disability
(2001-2010)
Productivity Gains
90 million US $
(2001-2010)
Conclusion
Women’s Right to Life and HealthU
NIC
EF
90-0
70/L
emoy
ne
Thousands of lives of
women and children
saved
Large increase in
women’s productivity
and income generating
ability
Four Conditions are Needed:
1. A strong
commitment to
maternal health
and survival by our
political leaders
and decision
makers
Four Conditions are Needed:
2. A clear focused
national
maternal health
and survival
strategy
Four Conditions are Needed:
3. A realistic,
appropriate, and
sufficient investment
in the maternal
health and survival
strategy
Four Conditions are Needed:
4. An implementation
framework with clearly
defined supervision,
monitoring, and
evaluation
mechanisms
Uganda,
“An Inspirational African Success Story in the Fight against HIV/AIDS”
Commitment Strategy Investment Implementation
Uganda can
Lead the
Fight against
Maternal
Death and
Disability
Enable Ugandan Women to …
Fully enjoy their rights
Fully contribute Uganda’s
Social
Economic, and
Political Development
JHU
/Ph
oto
Sh
are
Thanks for Your Attention
The REDUCE analysis in Uganda was undertaken under the leadership of the Ministry of Health, Reproductive Health Division, in collaboration
with:
The Regional Center for Quality of Health Care The Commonwealth Regional Health Community Secretariat The Makerere University, Dep. of Obstetrics and Gynecology The Makerere University, Dep. of Women and Gender Studies The Institute of Public Health, Makerere University, The Mukono District Health Team
with support from USAID’s Africa Bureau through the SARA Project and
USAID’s Global Bureau through the Quality Assurance Project
Ominde J. Achola, Commonwealth Regional Health Community Secretariat (ECSA)
Grace Bantebya-Kyomuhendo, Makerere University, Dep. of Women and Gender Studies
Dan Kaye, Mulago Hospital Dept. of Obstetrics and Gynecology
Essau. F. Katumba, Ministry of Health
Sarah Katumba , Mukono District Health Team
Sarah Kibuka, Commonwealth Regional Health Community Secretariat (ECSA)
Florence M. Mirembe, Makerere University, Dep. of Obstetrics and Gynecology
Michael Mubiru, Makerere University,
Edirisa Musisi, Mukono District Health Team
Twaha S. Mutyaba, Mulago Hospital, Dep. of Obstetrics and Gynecology
Susan W. Wandera , Mukono District Health Team
Christine Zirabamuzaale, Institute of Public Health
Joachim M. Zziwa, Mukono District Health Team
Produced by the REDUCE Team in Uganda