A lack of Basic Surgical Supplies and Trained Personnel Threatens Progress
World Lung Foundation convened a “Summit on Stopping Needless Maternal Deaths” this week in Dar Es Salaam to address the unacceptably high number of deaths among women during childbirth in Tanzania. The summit brought together key personnel working in rural districts in Tanzania with high-level officials from the Ministry of Health and Social Welfare and non-governmental organizations to address the multiple challenges fueling the crisis.
The primary reasons for maternal deaths in Africa are the delays associated with receiving adequate care when women suffer complications due to childbirth. This has to do with a shortage of medial personnel, poor transportation, and women waiting too long to seek the care they need. According to latest estimates, there are about 450 deaths from pregnancy-related causes per 100,000 live births.
PROGRESS THROUGH TRAINING AND INFRASTRUCTURE
To make skilled care more accessible in rural areas, World Lung Foundation, with financial support from Bloomberg Philanthropies has implemented a Comprehensive Emergency Obstetric Care (CEmONC) program in 17 rural health facilities in Kigoma, Morogoro and Pwani, including 12 health centers and 5 hospitals. The program has trained 50 non-physician clinicians – Assistant Medical Officers – in obstetrics care, including Assisted Vaginal Delivery (AVD), vacuum extraction, C-Section, Manual removal of placenta, and other skills, and has also trained 24 nurse midwives. In addition, WLF has built new maternity wards and operating theatres that are fully equipped with surgical equipment, reliable supplies of electricity and clean water. To enable skilled staff to live close to these facilities in remote village areas, 26 staff houses have also been built.
Between January 2008 and November 2010, there has been significantly improved capacity. Community acceptance is demonstrated by a 127% increase in deliveries at the health centres overall. While initially, none of the health centres provided emergency obstetrics care. By December 2010, seven of the ten health centres provided life-saving obstetric surgery.
In addition, 418 C-section deliveries were done, 76% of which were absolutely indicated (life-saving).
THE SUMMIT
Despite these efforts and the efforts of many NGO’s and others working in maternal health here, the challenges discussed at the Summit include a persistent shortage of skilled medical staff along with incentives to retain them; a lack of a regular and dependable supply of blood, drugs and the resources needed to secure them; and an unreliable distribution of basic supplies. In some instances, the lack of such basic needs as gauze, bandages, surgical masks and gloves can stand between a woman’s life and death.
Fifty representatives from dozens of organizations and districts gathered to coordinate a unified response to the crisis. Among those present included Dr. Margareth Mhando, Director of Curative and Hospital Services, Ministry of Heath and Social Welfare; Dr. Staffan Bergstrom, Director of Maternal Health, World Lung Foundation; Dr Koheleth Winani, National Coordinator, Safe Motherhood. Topics for discussion included improving the supply of blood, surgical material and anesthesia; coordination and efficiency among maternal health organizations; and innovation in pay-for-performance initiatives.
Quotes
Dr. Staffan Bergstrom, WLF’s Project Director, said, “Every organization attending this summit bears responsibility for the successes and failures of maternal health in Tanzania. The main objective of this summit to identify the inefficiencies and ensure they do not further threaten the progress that has been made. It is unacceptable, for example, that supplies as simple and critical as gauze bandages, surgical gloves and masks are unavailable to assistant medical officers. This means that there is a breakdown somewhere between the governments budgeting process and the field that is costing lives.”
Dr. Margareth Mhando, Director of Curative and Hospital Services, Ministry of Health and Social Welfare, said, “Every hour at least one woman in Tanzania dies as a result of pregnancy and childbirth. And for every woman that dies, another thirty suffer a debilitating injury, often with life-long consequences. Our Ministry is dedicated to stopping these needless death and injuries and we thank WLF for not only organizing this summit but for their efforts with us to save lives.
About World Lung Foundation
World Lung Foundation was established in response to the global epidemic of lung disease, which kills 10 million people each year. The organization also works on maternal and infant mortality reduction initiatives. WLF improves global health by improving local health capacity, by supporting operational research, by developing public policy and by delivering public education. The organization’s areas of emphasis are tobacco control, maternal and infant mortality prevention, tuberculosis, HIV/AIDS, asthma, and child lung health. For more information, please visit worldlungfoundation.org