Improve Maternal Health

Improve Maternal Health

Indicators:

5.1 Maternal mortality ratio

5.2 Proportion of birth attended by skilled health personnel.

The Millennium Development Goal 5 The Millennium Development Goal 5

Achievements:

Progress towards MDG 5 on maternal health is monitored through achievement of two targets and their associated indicators- Target 5 A: reduce maternal mortality by three quarters between 1990 and 2015, and Target 6. B: to achieve universal access to reproductive health by 2015

  • Guyana has made significant progress in both targets. Progress is seen in the decreased maternal Mortality Ratio from 270% (1990) to 86 % in 2012; Contraceptive prevalence rate has increased from 32 % to 46% which indicates that more people are planning their families and using services. Attention to sexual and reproductive health as part of the full continuum of care will save lives and reduce later costs.
  • Guyana benefited from support from the UNFPA Maternal Health Thematic Fund (MHTF), which supported an assessment in 2010 of all health facilities, to ascertain where the issues are and identify the gaps and upgrades needed to improve the capacity of facilities to provide emergency obstetric and newborn care (EmONC)
  • The Ministry of Health works at various levels to address the areas identified for upgrading, including administrative facilities, and at the Midwives and Doctors Associations and to provide: policies, institutional strengthening and human resource capacity building such as ALARM training for doctors and midwives, and training in Anesthetic services
  • Work in progress- the MOH collaborates with the Midwives Association and UNFPA to boost morale by providing an annual recognition programme which is done at the annual International Day of Midwives
  • MOH post graduate training in Obstetrics and Gynecology at the Georgetown Public Hospitals, with the support of Universities abroad
  • Guyana achieved target 5.A by 2008, since according to the national the country reduced the MMR from 320/100,000 live births in 1991 to 86/100,000 live births in 2008.  The main strategic activities conducted to get this progress are:
    • Availability of skilled health personnel at births
    • Antenatal care (ANC) coverage over 80% at health centres level
    • The proportion of mothers receiving at least one session of antenatal care has increased from 92% in 2000 to 97.2 in 2009

Main Areas:

  • UNFPA has supported the Ministry of Health through the Maternal Health Thematic Fund from 2009- 2012 and continues to provide support in the area of improving Maternal Health, Family Planning, institutional and human resource strengthening, done through facility upgrades to provide EmONC, equipment for schools of midwifery and the Midwives Association, to improve midwifery practice and bring this in line with acceptable standards, and training for HCW and establishment of protocols.
  • UNFPA supports human resource strengthening through continuing education for midwives and doctors, Institutional Capacity- equipment and materials such as toolkits midwives
  • Capacity of Guyana Midwives Association was enhanced through achievement of membership in the International Confederation of Midwives (ICM); as a result Guyana’s Midwives Association now has international support for midwives to participate in international conferences and training workshops. This supports the MOH’s work on authorizations and policy/legislative frameworks.
  • Family planning and RHCS - Meeting unmet need for family planning services and expanding coverage of quality services for maternal and newborn health can reduce maternal mortality by over 70 per cent and child mortality by over 40 per cent. Simply meeting unmet need for modern family planning can reduce unintended pregnancies by more than two-thirds, and unsafe abortion by more than 70 per cent. UNFPA continues its support of the MOH to improve FP services through the RHCS initiative which aims to provide a variety of methods and mix of RH commodities such as contraceptive pill, IUD, Injectable and the barrier methods male and female condoms. The work includes improved chain management system of forecasting, requesting and stocking of a mix of commodities, accessible and demanded by women and men.
  • Established midwifery focal points in almost all ten regions- their function is to assess and plan to reach midwifery needs
  • Adolescent Health- Very young women face significant health risks associated with pregnancy and childbirth. Adolescent fertility rates globally have declined as part of a dynamic process of increasing education, delaying age at marriage and expanding contraceptive use. However, they remain high and stable in countries with already elevated levels. In Guyana adolescent pregnancies are not uncommon. (MOH stats for 2009 record 2,900 live births to girls in the 15-19 age group, and this is only for the Government facilities). Differentials based on rural/urban location, education level and wealth remain dramatic. Education, including comprehensive sexuality education, can narrow the differentials. There is also the mismatch between the age of consent and the age at which adolescents can access RH services. UNFPA continues its support and advocacy for adolescent access to information and services.
  • Guyana achieved target 5.A by 2008, since according to the national the country reduced the MMR from 320/100,000 live births in 1991 to 86/100,000 live births in 2008.  The main strategic activities conducted to get this progress are:
    • Availability of skilled health personnel at births
    • Antenatal care (ANC) coverage over 80% at health centres level
    • The proportion of mothers receiving at least one session of antenatal care has increased from 92% in 2000 to 97.2 in 2009

Main challenges:

  • The further reduction in maternal deaths towards the achievement of the MDG 5 target.
  • Retaining trained midwives
  • Successfully upgrade the requisite number of facilities to Basic and Comprehensive levels and increase the availability of necessary infrastructure and materials- such as availability of blood and authorization to perform all signal functions

Health

The Government of Guyana is working based on the global principles of EQUITY, SOLIDARITY and RIGHTS, the National Health Strategy named “Health Vision 2020” which covers the period 2013 to 2020 is already written and need the final steps for validation.
The big challenge for the Government is the IMPLEMENTATION of the Strategy.
The National Strategy “Health Vision 2020” is based on:

  • Straightening the integration of Health Care Services delivery based in Primary Health Care Strategy. This strategy is centered in the person and community. All services in the country should work in an integrated network manner with reference and contra reference system previously standardized.
  • Human Resources National Action Plan was accepted by the MoH. This action plan is based on the strengthening of HR development (in number, distribution across the country and training and skills to respond the need of the population) and providing to them with the adequate working conditions. We are working with the MoH, UG and Health professional schools for providing to young professionals with adequate curriculum for their training.
  • PAHO is working with the MOH for the development of the 3rd Edition of the Package of Publicly Guaranty Health Services (PPGHS). This edition has specific characteristic of identifying the levels of services, the basic services provided in each of these levels and the resources (HR, equipment and medicines) that should exist permanently in those levels to have the capacity of resolution. 
  • The Government is working in the review of Legislation in Health to update accordingly the new challenges that the country is facing with the epidemiology and population changes.

We consider that if the Government works on the IMPLEMENTATION of the National Strategy in a short time, the whole Health system in the country will be improved and as I already explained this is actually focused in the PHC and Health care Services in the interior and those in remote areas of the country will be strengthened.