It is of great concern that the maternal mortality ratio in South Africa remains much higher than that of comparable peers with similar economies and comparable levels of public health spending.
It was within this frame of thought that the Maternal Health Workshop hosted by ReSEP, a research group on Socio-Economic Policy situated within the Department of Economics at Stellenbosch University (SU), took place on Monday 25 January.
“We care about mothers who die and who are not there to raise the children they conceived. We care about the children who grow up without knowing their mothers. We care about mothers and babies who experience poor health, physical pain and emotional distress that could have been prevented or avoided, had they received adequate health care,” Prof Ronelle Burger, from
the RESEP health group, said as an introduction.
The importance of quality and efficiency within the health care system was highlighted.
Dr Yogan Pillay from the National Department of Health explained that after 1994 the initial focus had been on improving access to care.
“I think for at least the first 10 years, quality lagged. We’ve been making some progress on quality since 2009 but we need to accelerate the provision of quality health care.”
He also spoke about efficiency: How to do more with less and where one would get the “biggest bang for your buck”.
Pillay mentioned that the national department of health had R517 million taken from its budget for 2016/2017 to fund, among other things, the drought relief initiative and university fees.
“We want to do more but we won’t have the resources, so efficiency is critical.”
Keynote speaker Dr Robert Pattinson from the Medical Research Council Maternal and Infant Health Care Strategies Research Unit identified some solutions for improving the quality of maternal and newborn care. They are:
- Improve quality of care around childbirth
- Consolidate services to provide economies of scale
- Continue to stress the importance of HIV and TB screening and treatment
- Concentrate on detecting and treating hypertension before birth
- Research into identifying and treating growth-restricted babies before birth
“Our quality of care is poor,” he said. “It has been found that 57% of maternal deaths were assessed to be possibly or probably preventable.”
He suggested that the department would get the “biggest bang for its buck” if they were to focus on improving delivery care, including Comprehensive Emergency Obstetric Care.
“Every maternity unit must have staff trained in emergency care and conduct regular emergency drills,” he added.
Prof Pattinson also argued that a vast majority of maternity units are, in fact, unsafe. Although there are sufficient midwives per district there are too many facilities for the staff available.
“Few community health clinics and district hospitals reach the critical mass of staff to provide a safe service and/or have sufficient deliveries to be cost effective. We need to consolidate services to ensure that the critical mass to run a safe unit is present,” he said. He added though that this raises difficult issues of access to services.
Prof Pattinson emphasised that the screening for HIV and TB should continue “with vigor”.
The rate of maternal mortality has declined drastically since 2009 and he ascribed it to a reduction in the number of deaths caused by non-pregnancy-related infections (NPRI). Many of the women who die are HIV positive and TB is the most common cause of death. Treating these diseases as early as possible could save many lives, as the reduction in the maternal mortality rate illustrated.
Next to NRPI, hypertension is the biggest cause of death.
Prof Pattinson explained that although it is impossible to predict who is going to experience trouble with labour, hypertension is something that CAN be picked up antenatally.
However, many health workers in the primary health care system don’t necessarily have the knowledge and skills to identify risk factors.
He suggested that attention should be paid to the management and detection of hypertension in antenatal care, for example by arranging for skilled staff to visit primary health care facilities.
Lastly he addressed the issue of unexplained still births.
“In 91% of the cases the mothers are healthy. However, only 10% of the population has access to ultrasound technology. Research needs to be done to develop a cost-effective method to detect growth-restricted babies before birth.”
Other topics that were discussed included the causes and correlates of late antenatal care access in metropolitan Cape Town, the Philani Mentor Mothers community health worker programme, the Thula baba box antenatal intervention and Maternal health and early childhood development in the Global Strategy's for Women's, Children's and Adolescents' Health. Speakers included Anja Smith, Laura Rossouw and Mark Tomlinson from Stellenbosch University, Kwanie Mbewu from Philani and Coceka Mnyani from WITS. The event was attended by a diverse and varied set of decision makers in maternal health including providers, researchers and policy makers.
Participants in the workshop found the conversation around these topics very enlightening and useful.
Prof Burger summarised that to achieve further gains in maternal health, involved parties will require a wider lens on the problem, a more encompassing perspective and specifically more frequent conversation.
Photo: Anja Smith, researcher at SU, Dr Yogan Pillay, Prof Robert Pattinson, Laura Rossouw, researcher at SU, and Dr Ronelle Burger.