Saving a Generation: Maternal, Newborn and Child Health (MNCH)

Eastern and Southern AfricaAga Khan Health Services

Today’s presentation

• Situation of Maternal, Newborn and Child Health (MNCH) in Sub-Saharan Africa, with a particular focus on Tanzania

• Approaches and impact of community interventions to improve mother and child health outcomes

ESA: maternal mortality amongst the highest in the world

“In 2010, close to 58,000 women [across Eastern and Southern Africa] lost their lives in pregnancy and childbirth, accounting for more than 1/5 of all such deaths in the world.

That’s close to 10 deaths every hour.”

- UNICEF

Tanzania’s maternal mortality rates are amongst the worst in an already bad situation

Rwanda

Burundi

Uganda

Kenya

Tanzania

0 300 600 900

Maternal Mortality Rate

Amongst highest maternal mortality rates in the world, Tanzania ranks 21st globally, tied with Afghanistan.

Child mortality rates are also unconscionably high

Tanzania

Under 5 mortality rate: 81 / 1000 live births

Infant mortality rate:51 / 1000 live births

Neonatal mortality rate:26 / 1000 live births

The neonatal mortality rate is the first 28 days after birth, and in Tanzania accounts for over 30% of all child deaths.

Largely, the problem is no skilled attendant at delivery…

…and most deaths are largely preventable

Haemorrahage

Infections

Eclampsia

Unsafe Abortions

Obstructed Labour

Others

0% 10% 20% 30%

Direct Cause of Maternal Deaths

Asphyxia

Congenital

Preterm

Infection

Diarrhoea

Tetnus

Other

0% 5% 10% 15% 20% 25% 30% 35%

Causes of Neonatal Deaths

But, there is progress in both maternal mortality rate…

1996 2004 20100

150

300

450

600

750

529 578454

Maternal Mortality Rate in Tanzania – 1996-2010

…and in child mortality rate

Newborn Infant Under-50

20

40

60

80

100

120

140

160

40

99

147

32

68

112

29

58

91

51

81

Child mortality in Tanzania (per 1000 live births)

1999200520082010

Still, there are large challenges in Tanzania’s health sector

Within health sector:

.Weak health infrastructure

.Limited human resources

.Poor referral systems

.Inadequate equipment and supplies

Community:

.Inadequate community involvement and participation in health

Other factors:

.Education levels

.Economic, social, & cultural issues.Gender dynamics

Still, there are large challenges in Tanzania’s health sector

Within health sector:

.Weak health infrastructure

.Limited human resources

.Poor referral systems

.Inadequate equipment and supplies

Community:

.Inadequate community involvement and participation in health

Other factors:

.Education levels

.Economic, social, & cultural issues.Gender dynamics

Why do we work in the community?

In Tanzania:• Out of a population of 40

million, 80% live in rural areas

• In rural areas, health infrastructure and services are limited

• Most people live below the poverty line and cannot afford to travel for health services

Outreach aims to: • Develop a relationship

with the communities• Stimulate behavioral

changes that improve health and prevent disease

• Improve maternal, newborn and child health indicators

And what exactly do we do?

Community support

Service delivery in communities Community

Meetings and Interactions

Health promotion activities

Develop links with referral

health facilities

Develop links with referral health facilities

• Links established through comms systems

• Ambulance services • Feedback mechanism• Follow-up

Government referral hospital

Aga Khan Health Services PCM

Public Health Facility

Teleconsultation Linkage

Service delivery in communities

Community meetings and interactions

Mobile health reach:• Regular outreach mobile

health visits to under-served rural areas

• Community training and empowerment

• Support to community health workers

Health promotion activities – education & entertainment

Community health camps:• Create demand• Raise awareness –

prevention, treatment care, social services

• Change attitudes to foster behavioral change

Outpatients at public health centres rose 6.5x last year…

37,971

243,676

30,000

80,000

130,000

180,000

230,000

280,000

2012 2013

Year

Number of Outpatient (Public Health Facilities)

…and deliveries in health facilities rose 11x

1,539

17,351

0

5,000

10,000

15,000

20,000

2012 2013

Year

Number of Deliveries (Public and Private Health Facilities)