Specialist assistants are able to perform resuscitation. born with well-defined vaccinations and messages on malaria prevention would also allow a wide audience to be reached in a short time. In Africa, maternal death audits have been well publicized and practiced, especially through the WHO “Beyondthe Numbers” program, audits that help program planners to produce the right kind of information needed to prevent maternal deaths.
19 Where women have died or were on the verge of death, there are usually many stillbirths associated with this and deaths of newborns. Audits of maternal deaths could include an analysis of fetal and neonatal deaths, as the deficiencies of the system that lead to maternal and newborn deaths are often the same. Stage to address the main gaps in the provision of health care as noted in
Continuing health care in African
Sections II and III , and as can be seen from country data on countries’ profiles in Section V, in most countries health service gaps include: • Low coverage of specialized care and COE, particularly for poor and rural communities (VideSection III, chapter 3) • Low coverage of Postnatal Control and little concrete knowledge about the quality of services provided at home and services (See Section III, chapter 4) •
- Systematic attribution of powers to the community for implementation changes in behavior and possible community interventions, especially specialized
- childbirth care. Specialized assistance during childbirth is a well-defined package, the improvement of which will be achieved more effectively if carried
- out by the services.20 This package has a high impact to save the lives of mothers and babies and to prevent stillbirths.
It is true that it requires a constant effort to bring services closer to families, to train and retain more midwives and more obstetricians in services, and to empower communities to demand quality services and have access to them. To achieve universal coverage in Sub-Saharan Africa, approximately 180,000 more partners are needed in the next ten years.21 This increase in human resources will require immediate planning, investment and concerted actions.
This is a long-term solution, and although resolving the problem requires provisional plans to be made, these should not be made at the expense of future investments in specialized health care.22 Postnatal Control and community-based packages are not as well defined as other packages, and much of the information comes from Asia and has to be adapted, tested and refined in different parts of Africa. In addition, the staffing of health personnel available at community level in African countries is much more unstable than in Asia.
Before deforming new staff
of health professionals at any level, an extremely careful assessment of their sustainability should be carried out. Table IV.1 presents ideas for phasing strategies according to the standard TMN and the capacity of health systems. In the place with the highest mortality rate, where the TMN is greater than 45 per 1,000 live births, most births162
Opportunities for Africa’s newborns occur at home, and although specialized assistance is scarce (33 percent), coverage by traditional birth attendants is even lower (20 percent) .23 More than half of births occur without any assistance. The World Health Report, 2005, describes this reality as a “state of massive deprivation” .21 In these locations, more than half of neonatal deaths are due to infections, including tetanus.23
Rapid decreases in TMN are possible with tetanus toxoid vaccination and with healthy behaviors at home.According to a new analysis made for this publication based on methodology used in the series of The Lancet on the survival of newborns, 24 the level of community and families could be avoided up to one third of neonatal deaths if human resources and specialized health care in health services were strengthened.
If policy makers and program managers
do not already start working to build a better health system, especially through improvements in specialized health care, the opportunity for more substantial progress to save the lives of mothers, newborns will be lost. births and children.The places in the middle of the table, with TMN values between 30 to 44 and 15 to 29, are what the World Health Report 2005 describes as “marginalized” .
- 21 Because they have more assets, urban populations in these countries have access to specialized assistance, but the poor and other marginalized populations do not. The
- solution lies in ending the bottlenecks that are opposed to improving services. At lower levels of TMN, there may still be great inequalities in coverage, especially with regard to
- very different interventions. In these situations, attention should focus on improving the quality of health care provided and the longer-term results related to physical disabilities.
If the 12 countries in Africa with the highest mortality rates started with the community level and proximity services, while reinforcing more complex clinical care packages, and making progress by introducing phased improvements through three gradual increases of 20 percent coverage, so that it reaches 90 percent of all essential interventions, so even with only the first 20 percent increment , about 171 000 newborns’ lives could be saved annually.
Half of African newborn deaths preventable through essential interventions (409,000 out of 800,000) occur in these 12 countries with high mortality (Table IV.2). The additional operating costs for phase 1 of the interventions in these 12 countries are estimated at 0.12 billion dollars, increasing from 0.22 billion to 90 percent coverage, a phase in which three quarters of the cost consists of providing care