Abstract
BackgroundThe failure to reduce preventable maternal deaths represents a violation of women’s right to life, health, non-discrimination and equality. Maternal deaths result from weaknesses in health systems: inadequate financing of services, poor information systems, inefficient logistics management and most important, the lack of investment in the most valuable resource, the human resource of health workers. Inadequate senior leadership, poor communication and low staff morale are cited repeatedly in explaining low quality of healthcare. Vertical programmes undermine other service areas by creating competition for scarce skilled staff, separate reporting systems and duplication of training and tasks.DiscussionConfidential enquiries and other quality-improvement activities have identified underlying causes of maternal deaths, but depend on the health system to respond with remedies. Instead of separate vertical programmes for management of HIV, tuberculosis, and reproductive health, integration of care and joint management of pregnancy and HIV would be more effective. Addressing health system failures that lead to each woman’s death would have a wider impact on improving the quality of care provided in the health service as a whole. More could be achieved if existing resources were used more effectively. The challenge for African countries is how to get into practice interventions known from research to be effective in improving quality of care. Advocacy and commitment to saving women’s lives are crucial elements for campaigns to influence governments and policy -makers to act on the findings of these enquiries. Health professional training curricula should be updated to include perspectives on patients’ rights, communication skills, and integrated approaches, while using adult learning methods and problem-solving techniques.SummaryIn countries with high rates of Human Immunodeficiency Virus (HIV), indirect causes of maternal deaths from HIV-associated infections now exceed direct causes of hemorrhage, hypertension and sepsis. Advocacy for all pregnant HIV-positive women to be on anti-retroviral therapy must extend to improvements in the quality of service offered, better organised obstetric services and integration of clinical HIV care into maternity services. Improved communication and specialist support to peripheral facilities can be facilitated through advances in technology such as mobile phones.
Highlights
The failure to reduce preventable maternal deaths represents a violation of women’s right to life, health, non-discrimination and equality
Advocacy for all pregnant Human Immunodeficiency Virus (HIV)-positive women to be on anti-retroviral therapy must extend to improvements in the quality of service offered, better organised obstetric services and integration of clinical HIV care into maternity services
Human Immunodeficiency Virus [HIV] infection is the most important condition contributing to maternal deaths in the southern Africa region, with HIV-positive women in South Africa more likely to die of any underlying cause in pregnancy than HIV-negative women [1,2,3,4]
Summary
Integration of HIV and maternity services One consequence of the impact of HIV on maternal mortality is that indirect causes of death exceed direct obstetric causes, with non-pregnancy related infections predominating [1,5]. Data from southern Africa show that the greater proportion of maternal deaths in HIV-positive women occur in the postpartum period, mainly from AIDS [11] Many of these women are still inpatients and need inter-specialist care in postnatal wards to prevent deterioration and death. A health systems approach takes account of the whole interconnected and multifactorial network of workforce, logistics, infrastructure, finance and data management that work together to deliver health services, rather than disease-focused or single-issue perspectives Proponents of such approaches warn against concentrating resources in vertical programmes, leaving other areas with fewer skilled staff, and not managing the interface between conditions.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.