Your Excellencies Members of the Panel, Distinguished Guests, Ladies and Gentlemen,
It’s a great honour and privilege to address this august gathering of eminent personalities. I would like in particular to express my profound gratitude to the organizers of the World Health Summit for creating this unique forum.
The theme of this session ‘Accelerating towards Achieving the Health MDGs 4 and 5’ is very pertinent at this particular point in time. With about five years left before the endpoint of the Millennium Development Goals, the slow progress in improving maternal and child health remains a matter of global concern particularly in sub-Saharan Africa.
I would like to make a quick review of essential interventions required to improve maternal and child health and the coverage of these interventions; and then I will refer to current maternal and child mortality trends and the health systems response to accelerate progress towards MDGs 4 and 5.
Distinguished Guests, Ladies and Gentlemen,
Looking at the fourth Millennium Development Goal to reduce child mortality by two thirds between 1990 and 2015, we see that the interventions required to attain this goal are well known. The key to making progress towards attaining this goal by 2015 is reaching every newborn and child with a set of priority interventions. These interventions include: Appropriate breast feeding and infant and young child feeding practices; prevention of vaccine preventable diseases through effective immunization and prevention and management of common childhood illnesses e.g. Pneumonia, diarrhea, malaria, malnutrition and HIV infection.
Generally, interventions that can be routinely scheduled and delivered, such as immunization, have much higher coverage than those that rely on 24-hour availability of clinical services such as care of sick children.
If we look at percentage of immunization coverage among 1-year old children for the third dose of Diptheria/ Pertusis /Tetanus (DPT3), we note that this coverage has increased in the African Region from 57% in 1990 to 72% in 2008. Despite this increase, the coverage level remains below the global average, which increased from 75% to 82% during the same period. The African Region and South-East Asia have the lowest immunization coverage for DPT3.
However, we find out that the access to new vaccines such as rotavirus and pneumococcal that could significantly reduce under five morbidity and mortality are not affordable to those who need them most. An initiative to improve access to such vaccines could significantly contribute to accelerate the pace towards MDG4.
When it comes to management of common childhood illnesses, only about 37% of children with diarrhea receive life-saving oral re-hydration therapy and only 43 percent of children with symptoms of pneumonia receive care by skilled health workers.
Distinguished guests, Ladies and Gentlemen
As I said earlier, for most childhood illnesses, the interventions for prevention and control are known but their coverage is limited. As a result, sub-Saharan Africa has made the least progress in improving child survival compared to all other regions in the world.
Global under-five mortality has reduced from 90 per 1000 live births in 1990, to 65 per 1000 live births in 2008. In the African Region, the under-five mortality rate during the same period has dropped from 182 to 142, but remains the highest of any region in the world.
Child mortality in the African Region is currently going down at an average rate of 1.4% per year. However, in order to meet the fourth Millennium Development Goal, African countries need to reduce mortality by at least 8% each year until 2015.
Currently, out of 46 countries in the region, only six are estimated to be on track to achieve MDG4 (Botswana, Cape Verde, Eritrea, Malawi, Mauritius and Seychelles). Twenty-seven are estimated to be making insufficient progress, while the remaining thirteen are not making any progress at all.
This situation calls for intensified support to scale up the delivery of chid health interventions, which presupposes the strengthening of health systems capacities at local level.
Distinguished guests, Ladies and Gentlemen,
Women play a crucial role in achieving sustainable socio-economic development. Despite the availability of tools and knowledge to protect women’s health, in the African region, women still face challenges in terms of survival. Pregnancy that normally should end with a new healthy life bringing untold joy to a mother, oftentimes results in tragic loss of life – either of the mother, the child or both.
Proven cost effective interventions exist and vast majority of maternal deaths could be averted if every woman had access to quality reproductive health services. These include family planning and skilled attendance during pregnancy, childbirth and the postnatal period. In addition, there is a need to strengthen the capacity of individuals, families and communities to improve their awareness, knowledge and behaviours towards maternal and newborn health.
Generally, coverage of skilled birth attendance in the region remains low at 47% with wide variation of the rates among countries. Looking at some of the specific interventions, only 12% of pregnant women requiring Emergency Obstetric Care actually receive it; and Caesarean Section rate is only 3.4% compared with the Americas which has the highest rate estimated at 31%. You will note that the global rate of Caesarean Section is about 14%.
The low coverage of these life saving interventions in the Africa Region has led to the highest maternal mortality rate in the world. This rate has now reduced from 910 per 100 000 live births in 1990 to 620 in 2008. For every maternal death, there are at least thirty women who suffer short- or long-term disabilities. The Maternal Mortality Ratio for other regions in 2008 was 320 for the Eastern Mediterranean, 240 for South-East Asia, 66 for the Americas Region and 51 for West Pacific Region. The European region has the least maternal deaths, standing at 21 per 100,000 live births. The overall global rate is estimated to be 260 per 100,000 live births.
The decline of maternal mortality in sub Saharan Africa over a 15 years period between 1990 and 2005 was only 0.1 per cent while to achieve MDG 5 we need at least a 5.5% decline per year.
Distinguished Guests, Ladies and Gentlemen,
The achievement of MDG 6 on Malaria, HIV/AIDS and Tuberculosis has great impact on maternal and child mortality rates
Malaria is responsible for 7% of under-five deaths globally and 16% in the African Region. It is also an indirect cause of maternal mortality and contributes to still birth, premature delivery and low birth weight.
Globally, the 2 top causes of deaths in women in reproductive age are HIV/AIDS (19%) and pregnancy related complications (15%). With regards to HIV/AIDS in Sub-Saharan Africa, 60% of all people living with HIV/AIDS are women. In 2008 alone, of all new HIV infections among children, 91% occurred in Africa and almost all result from mother to child transmission.
Looking at tuberculosis, globally almost 40% of new cases in 2008 were women. Co-infection of HIV and Tuberculosis accounts for over 25 % of deaths among women of reproductive age.
Now, I will refer to the impact of MDGs 1 and 7 on MDG 4 and 5. Starting with MDG1, there is evidence that malnutrition increases the risk of maternal and child mortality. Moreover in the last two decades, the high percentage of undernourished children remains unchanged, and this partially explains the slow progress in achieving MDG4. Anaemia affects 57% of pregnant women in Africa, raising the risk of premature birth, low-birth-weight, haemorrhage and sepsis.
Regarding MDG 7, the percentage of the world’s population using “improved” drinking water sources increased from 77% to 87% between 1990 and 2008. This rate is sufficient to achieve the relevant MDG target globally. In the WHO African region, however, while the percentage increased from 50% in 1990 to 61% in 2008, it remained off-track for achieving the MDG target.
In 2008, 2.6 billion people were not using “improved” sanitation facilities. The situation was most severe in the African Region, where the percentage of the population using improved sanitation facilities increased very slowly: from 30% in 1990 to 34% in 2008.
The inadequate availability of clean water and improved sanitation has a negative impact on incidence and prevalence of childhood illnesses
Distinguished Guests, Ladies and Gentlemen
In the African Region, weak health systems have been a hurdle to scaling-up coverage of essential health interventions. The renewed focus Primary Health Care with its principles and values of social justice, equity, solidarity, effective community participation and multi-sectoral action, offers a sustainable approach to redesign national health systems in a flexible manner to respond to maternal and child health needs.
Policy and governance should take into account aspects of human rights, gender and equity as well as women’s empowerment. Health policies and plans should prioritize maternal and child health. There is also need to ensure that other areas of government policy and legislation promote the health of mothers and children.
Countries should develop comprehensive health financing policies.
Health care financing strategies including government budget, international funding, social health insurance and out-of-pocket expenditures need careful review and reforms.
The African Region continues to face a critical shortage of human resources for health with only 2 Physicians/10,000 population and 11 nursing & midwifery staff /10,000 population. An evidence-based health workforce planning and monitoring as well as adequate training, deployment, retention and career development is needed to address the current human resources needs.
In relation to health technologies, there is a need for a better access to quality and safe health technologies.
Improving generation of evidence and information is also required for policy making, accountability, resource allocation and performance.
In summary, Ladies and Gentlemen,
Progress on MDGs 4 and 5 could be improve by:
- Renewed national and international commitment and ad more effective leadership in health;
- Increased and sustained resources by governments and partners;
- Access to available new technologies the can positively impact maternal and child health;
- Efficient and effective use of resources at national level;
- Empowering communities and gender main streaming and
- Improved generation of evidence through information systems and research.
Distinguished Guests, Ladies and Gentlemen
I am confident that if we all pull together our efforts, we will be able to make good health and well being a reality for the millions of mothers and children that are still left behind.
We need to act now…for tomorrow is too late.
Thank you