Madagascar has a strong tradition of community involvement and effective community-based programs. For more information on TMN, GNI per capita and other indicators used in this box, see Section V for country profiles and notes on the data. Donons sa chance à chaque nouveau-né de l’Afrique 157What are the factors driving IVprogressions to save lives? All countries differ from each other, but there are four themes shared by countries that are making progress in MNCH and which are the ABCs of progress:
Responsible leadership : in many of these countries, it is an consistent and responsible leadership and good management of resources that guides the way forward and the actions to be taken. Good leadership not only maximizes teamwork in a country, state or organization, but also attracts investment from outside sources. The Paris Declaration on aid effectiveness established the fundamental principle of being the government that leads and that partners have to respect it. three principles: ”4 • A national plan
A coordinating mechanism
A monitoring and evaluation mechanismHow to link national policies with district measures: almost all of these countries have documents on poverty reduction strategies and health sector reform plans. There is often a gap between strategic planning at national level and measures taken at district level. Tanzania has created an instrument that allows districts to allocate funds from local budgets according to certain identified categories of diseases most present in the places concerned,
- which have increased spending on child survival that are associated with steady increases in coverage of essential interventions. Empowerment of the community and
- families: many of the health care provided to mothers and newborns take place at home, where women and their
- families are not spectators. If empowered, they can be part of the solution to save lives and promote healthy behaviors.
In Senegal, a neonatal health committee has been created whose action is aimed at health services and also the community. This committee creates and strengthens links between those two realities of society and involves key partners at national and regional levels. In one area, a project supported by the BASICS organization, improved health services through the training of health professionals, stimulating monitoring, and the provision of basic equipment.
Counseling through community health workers (TCS) and volunteers and semi-skilled service workers has also improved. Simultaneously with the use of the media, these communication strategies resulted in an improvement in family behaviors, such as preparing for childbirth or saving money for emergencies (from 44 percent to 78 percent), drying the baby right after birth. childbirth, when he is born at home (from 54 per cent to 73 per cent),
Initiation of breastfeeding
in the first hour after childbirth (from 60 per cent to 78 per cent), and avoiding pre-dairy foods (from 39 per cent to 71 percent) .5 Demonstrated commitment to: • Create and encourage policies to support the 4th and 5th MDG objectives and increase coverage of essential MNCH interventions and packages. Both the Roadmap and the Regional Framework for Child Survival pay the utmost attention to increasing the coverage of essential interventions.
- In the 5 and 10 year plans, constant and consistent attention must be paid to essential MNCH packages in order to achieve universal coverage, especially with regard
- to the packages that raise the most difficulties. • Maximize the potential of human resources, including the use of
- community staff when appropriate. In order to improve specialized assistance, it is very important that there is a permanent commitment to increasing the capacities of human resources.
The International Federation of Gynecologists and Obstetricians (FIGO) supported the establishment of links between professional associations in developing countries and those in developed countries to improve the capacity and improve the quality of health care. From Uganda we have a success story, in which two districts were able to demonstrate that COE was needed and did so by improving the quality of services and stimulating demand in communities.6 (See Section II, Box II.5)
Measure progress and link the data obtained with the decision-making process, always considering equal criteria in monitoring and in the evaluation of efforts to improve services. Some countries have used new methods to use the available data and promote accountability by the authorities. Every year, for example, Uganda newspapers publish a table of all districts that will show progress in health and education and other key indicators.
South Africa has instituted a confidential
national survey on maternal deaths7 and also has a process to analyze neonatal deaths and their causes.8 • Mobilize resources to protect the poor. Mobilizing resources to protect the poor and move towards a more egalitarian health system requires a very careful analysis of moderator rates. Even with better supplies and improvements in service quality, moderator fees reduce the use of health services.9;
- 10 Moderator fees paid by service users make some essential health care, such as hysterectomy, prohibitively expensive. An analysis comparing the costs of maternal
- “near death” cases and the associated obstetric costs made in Ghana and Benin, concluded that the cost of this care can be so high that it reaches up to one third of a family’s annual income.11
- Figure IV.1 shows the estimated percentage of expenses with moderating fees in health services in 44 countries.
In most158 Opportunities for newborns in Africized countries in southern Africa, less than 20 percent of health expenditures refer to out-of-pocket fees, largely due to the existence of better social security systems in these countries. However, the 17 countries with the highest spending on moderating fees are located in the poorest African sub-region, in West and Central Africa, with 40 to 80 percent of health expenditure to be paid directly by families.
Various analyzes suggest that exemptions from moderating fees based on socio-economic status are very difficult to implement12; 13 and that exemptions based on demographic data (eg age, pregnancy) may be more effective.10; 14 Abolishing moderating fees can greatly increase demand services and overburden the system,