North-South Korea maternal health project to continue

Abstract

Political tensions between North and South Korea should not affect a successful joint programme to improve maternal and child health in North Korea, say officials. Justin McCurry reports. A South Korean-funded programme to improve the health of women and children in North Korea has so far been unaffected by the political crisis on the peninsula. Since its launch 4 years ago, the programme has resulted in substantial improvements in the health of 7 million people, particularly mothers, newborn babies, and young children, according to Eric Laroche, assistant director-general for health action in crises at WHO. “I was really impressed by the effectiveness of the programme that has been set up”, Laroche told reporters after a recent 4-day visit to North Korea. South Korea has poured about US$30 million into the Integrated Management for Childhood Illness programme and plans to allocate another $13 million this year. It has indicated that despite a recent tightening of sanctions against its neighbour, health and other humanitarian projects will be unaffected. Paul Garwood, communications officer for WHO's health action in crises, told The Lancet: “We are unaware of any change to the various health projects that WHO, [North Korea and South Korea] are jointly working on in North Korea, including the child and maternal health project. WHO is liaising with both countries and is following the situation closely.” Despite a crumbling economy and the ever-present fear of famine, the Pyongyang regime has won praise from international observers for improvements in the quality of services offered by specially targeted hospitals. The child and maternal health programme has brought about a substantial reduction in deadly diarrhoeal diseases in children. Additionally, two paediatric and two maternity hospitals have been renovated and supplied with medicines and laboratory equipment, WHO said in a statement. “It is an extremely cost-effective measure that gets a high rate of return in terms of incidence of disease, in terms of reduction of mortality, and so on”, Laroche said. “Along with that there were strategies to reduce the ill health of mothers and to reduce maternal mortality with emergency obstetric care.” WHO statistics support his upbeat appraisal. The number of operations undertaken has increased 8% since 2006, while postoperative infection rates have fallen by more than 42%. Additionally, the number of deaths during operations has dropped 73% in 2 years, while postoperative deaths are down by more than half. Over the same period, North Korea has trained more than 6000 health professionals in emergency obstetric care, newborn care, and the management of childhood illnesses. The project is in place in 80 of North Korea's 220 counties, and there are plans to take it to other parts of the country over the coming years. But other recent studies paint a less rosy picture of the health of North Koreans, who have had to endure floods, famine, and falls in aid because of international sanctions imposed after the regime did nuclear tests in 2006 and last year. Early this year there were reports of starvation after North Korea botched an attempt to revalue its currency, a move that sent prices skyrocketing and destroyed household savings. The most recent report shows that life expectancy in North Korea has declined over the past 15 years, together with rises in child mortality and the number of women dying in childbirth. According to the survey, done with the help of the UN Population Fund, infant mortality rose from 14 per 1000 livebirths to 19 per 1000 livebirths between 1993 and 2008, while the maternal mortality rate rose from 54 deaths per 1000 livebirths to 77 per 1000 livebirths. Although aid workers familiar with the country say that North Korea's health service is well run, they warn that recent political turmoil has made it difficult to operate on the ground. “Everything we are doing in North Korea has been put on hold”, Wolfgang Gerstner, North Korea programme consultant for Caritas International, the Catholic relief agency, told The Lancet. The group has been involved in maternal and child health care. “I have visited maternity clinics and the story is always the same”, Gerstner said. “They have the staff, but the buildings are poorly maintained and there are shortages of food, medicine, and equipment. You can find clinics where the staff are very motivated, but there are also some very desperate situations.”