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A number of non-traditional practices are arising in poor and developing communities to fight high maternal mortality rates. One example that has taken hold in many African countries is the use of non-physician clinicians (NPCs) – health care providers who are not licensed physicians but who still provide substantial medical care. The retention rate of these types of practitioners tends to be higher, and the cost of training and deployment much lower, than those of doctors.
At a recent conference, health delegates from 42 countries agreed to implement a new strategy that trains NPCs in emergency obstetric surgery to address the lack of health care workers. Along with other developing areas, most African countries are suffering from a significant lack of medical professionals. This shortage is particularly implicated in the high rates of maternal and infant deaths during childbirth. The WHO has estimated that in sub-Saharan Africa alone, there is a shortage of nearly 1.5 million health care workers; women there face a 1-in-13 risk of dying in childbirth. Most women are unable or unwilling to access medical facilities or workers, even during emergencies; for example, in Ethiopia, only 6% of all births occurred in a health facility.
By expanding the number of NPCs and training them in surgical childbirth procedures, it is hoped that more births will be attended by trained health care workers who can assist women during emergencies. A program in Mozambique that trains midwives in surgical techniques has already achieved significant results. The country is on the way toward meeting several of the UN’s Millennium Development Goals, particularly those surrounding maternal and newborn health.
In a similar low-tech program, USAID’s maternal health group ACCESS (Access to Clinical and Community Maternal, Neonatal, and Women’s Health Services) focuses on developing and extending home and community based interventions. A new report from ACCESS is a guide for carrying out “community mobilizations” to improve maternal and newborn health. The program focuses on identifying the specific obstacles of the community, and working with the population to implement realistic changes. For example, essential interventions like the use of misoprostol (which induces labor) can generally be provided safely by trained health care workers at the household and community level, and prevent almost 70% of infant deaths. Additionally, simple preparations, such as providing folic acid to the mother during pregnancy and preparing a clean space for the birth, can be done by community health workers trained in pregnancy and childbirth.
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