Tracing the Historical Foundations of Maternal and Child Health to Contemporary Times

Samson Udho
MSc, BSc
udhson10@gmail.com
 Outline
 Trends in maternal health
 Trends in child health
 Global commitment to MCH
 Regional commitment to MCH
 National commitment to MCH
 Maternal Health
Maternal morbidity and mortality are the two major indicators of maternal
health.

Others are antenatal care attendance, skilled delivery, facility delivery

Maternal morbidity and mortality relate to illness or death occurring during

pregnancy or childbirth, or within two months of the birth or termination of
a pregnancy.

Uganda’s current maternal mortality ratio is 336 deaths/100,000 live births

3336 deaths/100,000 live births
• 36 deaths/100,000 live births
 Child Health
 Child health encompasses life of a newborn up to
adolescence

 Major Indicators of child health are; neonatal mortality,

infant mortality, under-five mortality and child mortality.

 Child mortality refers to the death of children under the age

of 14 and encompasses neonatal mortality, infant mortality,
under-5 mortality, and mortality of children aged 5–14.
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Maternal mortality ratio 336 deaths/100,000 live births

Neonatal mortality 27/1000 live births

Infant mortality 43/1000 live births

Under 5 mortality rate 64/1000 live births

Child mortality rate 22/1000 child surviving to age 12

months

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 Global commitment to MCH
 Addressing maternal and child health issues gained moment when the leading
organizations came together in sept. 2005, Delhi, India.
Partnership for Safe Motherhood and Newborn Health, hosted by the
World Health Organization in Geneva;
The Healthy Newborn Partnership, based at Save the Children USA; and
The Child Survival Partnership, hosted by UNICEF in New York.
 All three partnerships focused on accelerating action by countries—both donor
and developing countries—to achieve then, the Millennium Development Goals
(MDGs) 4 (reduce child mortality) and 5 (improve maternal health).
 The Three Historical Partnerships

1. The Partnership for Safe Motherhood and Newborn Health

 Was an outgrowth of the Safe Motherhood Inter-Agency Group,
which was established in 1987.

 This Partnership was launched in 2004 with a broadened mandate to

promote the health of women and newborns, focusing on the most
vulnerable groups.

 It also lobbied for greater national and international commitment to

achieve MDGs 4 & 5.
2. The Healthy Newborn Partnership
 Was established in 2000 with three main objectives:
(1) promoting awareness and action to improve newborn
health;
(2) providing a forum to communicate new advances and
information in newborn health initiatives; and
(3) incorporating newborn health into government policies
and programmes.
3. The Child Survival Partnership
 Was created in 2004 to improve the efficiency and the
effectiveness of child health programmes, and to lobby for
governments to support and expand national child health
initiatives.

 The Partnership strives to achieve these goals by bringing

together national, regional, and global partners in a shared
effort to mobilize resources and achieve MDG 4.
 Regional commitment
The Abuja Declaration: Ten Years On
 In April 2001, heads of state of African Union countries met and
pledged to set a target of allocating at least 15% of their annual
budget to improve the health sector.

 To date, Uganda only commits < 4% of her National budget to

health sector

 Implying the health sector in Uganda is largely still donor driven

 Tracing National Commitment to MCH
 The Constitution of Uganda sets out the State’s duty to ensure all Ugandans
enjoy access to health services and to take all practical measures to ensure
the provision of basic medical services to the population.

 The national Safe Motherhood Program (SMP) has been a pillar in the
promotion of maternal health in Uganda.
 As part of this program, a number of initiatives were established in the last decade,
including;
building a supportive community network of traditional birth attendants
(TBAs)
interventions to forecast high-risk obstetric events and strengthen referral
systems.
 The national population policy of 1995 seeks to reduce fertility and
maternal morbidity and mortality by promoting informed choice,
service accessibility and improved quality of care
The policy seek to reduce fertility rates and deaths accruing from
high fertility

 In 1996, the government adopted universal primary education as a

strategy to improve population literacy
This policy has increased the school enrolment of both girls and
boys.
In the long term, it is hoped that the benefits of schooling will be
reflected in maternal and reproductive health indicators
 In response to the lower status of women in many parts of the
society, the government adopted a national gender policy in 1997
with the goal of integrating gender into community and national
development
 The policy intends to empower women in decision-making
processes as a key to development
 In recognition of the special reproductive health needs of
adolescents, the government has drafted an adolescent health
policy in 2004.
The policy seeks to promote adolescent friendly services, sex
education and building life skills.
In addition, the policy sets the minimum age for marriage at 18
years to counter the high rates of adolescent pregnancy
 The National Malaria Control Strategy of 2011 has lead to progress
towards effective malaria control through ITNs and internal
residual spraying (IRS) in low lying and epidemic prone areas
This policy was hoped to reduce maternal and child mortality
related to malaria

 In 2010, the Global Strategy for Women’s and Children’s Health

was launched by the office of the United Nations Secretary-
General. The Initiative calls for a bold, coordinated effort around
MDGs 4 and 5, building on what has been achieved so far - locally,
nationally, regionally and globally.
 It calls for all partners to unite and take action – through enhanced financing,
strengthened policy and improved service delivery.
 Uganda made the following commitments to the Global Strategy:
Ensure that comprehensive Emergency Obstetric and Newborn Care (EmONC) services
in hospitals increase from 70% to 100% and in health centers from 17% to 50%.

Ensure that basic EmONC services are available in all health centers; ensure that
skilled providers are available in hard to reach/hard to serve areas. Uganda also
commits to reduce the unmet need for family planning from 40% to 20%.

Increase focused Antenatal Care from 42% to 75%, with special emphasis on
Prevention of Mother-to-Child Transmission (PMTCT) and treatment of HIV.

Ensure that at least 80% of under 5 children with diarrhea, pneumonia or malaria
have access to treatment; to access to oral rehydration salts and Zinc within 24 hours,
to improve immunization coverage to 85%, and to introduce pneumococcal and
human papilloma virus (HPV) vaccines.
 Moving Forward
 Since 1990, there has been an over 50% decline in preventable child
deaths globally.

 Maternal mortality also fell by 45% worldwide. 

 The struggle is on….now we have the SDGs.

 Countries have new commitments to achieve these goals.

 But the forces behind those commitments remain largely the same.
 Conclusion
 MCH is one major indicator of a country’s progress.

 There is more government effort geared towards it than

other units.

 Nonetheless, Uganda continues to struggle to meet her

new MCH targets.
Thank you