Editorial by Aku Kwamie and Augustina Koduah
On 27 – 28 March 2012, experts, activists and high-level government officials were invited to Kampala, Uganda, where the Africa Regional Consultation on Achieving MDG 5: Challenges, Opportunities and Lessons Learned, was held. Sponsored by Women Deliver, this meeting was the first in a series of planned regional gatherings in the run-up to 2015. It was fitting that the first Regional Consultation should be held in Africa, given the region’s global burden of continued maternal mortalities and morbidities. The Africa Region Consultations were followed by the 126th Inter-Parliamentary Union Assembly, from 31 March – 5 April 2012, where for the first time, a resolution on maternal, neonatal and child health, “Access to Health as a Basic Right: The Role of Parliaments in Addressing Key Challenges to Securing the Health of Women and Children”, was debated among 120 countries. These meetings occur in advance of the deadline of 2015 to achieve MDG 5.
This focused attention on maternal health is encouraging. It reminds us that maternal mortalities and morbidities reflect serious inequities, not only across countries, but within them, and that such problems point to weaknesses within health systems. This becomes clear when we consider how quickly a ‘normal’ delivery can become dangerous if the needed referral system is fragmented or non-responsive. There is no doubt that technological and infrastructural inputs are important in supporting access to maternity services, however, on their own they are not the answer. Concerted efforts to address the nexus of where social, economic, and clinical failings result in poor maternal outcomes must be included. As such, systems-based perspectives must embrace an understanding of the relationships and decisions manifest at all levels across the system – from mothers and their communities, to front-line workers, managers, and policy-makers – which underlie the reasons services do (or do not) get accessed, and the ways in which services are (or are not) delivered.
For example, in Ghana several health system approaches are being undertaken to ensure not only that women have access to maternity services and are financially protected, but also that those services are improved to be of higher quality. The current health sector Programme of Work (2012-2014) has as one of its five objectives to ‘improve access to quality maternal, neonatal , child and adolescent services’. It is through this strategy that the country’s MDG Acceleration Framework to achieve MDG 5 will be put in practice to address the system bottlenecks surrounding family planning, skilled delivery, and access to emergency obstetric and neonatal care. For Ghana, reduction of the maternal mortality rate from 451/100,000 (2008 figures) to 185/100,000 (MDG target), particularly in a context of high political will and a growing economy remains a national priority.
As global MDG meetings continue to be convened, individual countries need to engage all system actors to seek their views on what is and is not working, and their understandings of the reasons why. A spotlight on maternal health gives us the chance to maintain efforts in strengthening health systems. In the MDG countdown, we should not be lured by ‘vertical promises’. Holistic, systems-based perspectives on addressing maternal health must not be forgotten. It is the only way MDG 5 will be achieved.