M aternal S urvival and H ealth A P athway to D evelopment in U ganda

MMaternal aternal SSurvival urvival

and and HHealthealth

A Pathway to

Development in Uganda

Application of the REDUCE Model in Uganda

Uganda: Sustained Economic Growth

Annual per Capita Income

US$

186

Uganda: Sustained Economic Growth

Annual per Capita Income

US$

186

330

$

$

Uganda: An Inspirational African Success Story

Uganda: An Inspirational African Success Story?

• Total fertility rate (TFR) 6.9

• Infant mortality rate (IMR) 97• Child mortality rate (CMR) 147

• Child stunting at 2 years of age 45%• Full vaccination at 2 years of age 44%• Access to safe water in rural areas 47%• Primary education completion 34%

HDI: HDI:

158/174

158/174

Maternal Death

“The death of a woman during

pregnancy, delivery, or the

six weeks following the birth

of her baby.”

(WHO, 1980)

UN

ICE

F/C

-55

-10

/Wa

tso

n

Maternal Mortality Ratios in Africa

1200

506

280250230

0

200

400

600

800

1000

1200

South Africa Botswana Zimbabwe Uganda UN UgandaEstimate

Source: UNFPA, 1999

Maternal Deaths/100,000 Live Births


1200

506

280250230

0

200

400

600

800

1000

1200


Source: UNFPA, 1999

Maternal Deaths/100,000 Live Births

Mothers’ Index

The Mothers’

Index ranks

Uganda 76

out of 106

countries

UNIC

EF/P

irozz

i

Source: Save the Children, 1999

Maternal Mortality

Maternal Mortality: a Small Part of a Larger Problem

Poor Healthand

Disability

UN

ICE

F/C

-79-

53/G

oods

mith

Women’s Participation in the Labor ForceU

NIC

EF

/C-7

9-53

/Goo

dsm

ith

Women’s economic contribution is crucial to reduce poverty

(Ugandan Labor Survey, 1998)

53%

Population Living in Absolute Poverty

Poor maternal health reduces

dramatically the capacity of

Ugandan women to grow out of

poverty

44%

(Source: UNICEF, 1999)

Investing in Safe Motherhood in Uganda

Increases Survival

Improves Health

Reduces Poverty

Major Causes of Maternal Mortality in Uganda

HIV/AIDSHIV/AIDSMalariaMalaria

AnaemiaAnaemia

Women’s Low Status

Lack of access to

and control of

resources

Limited access to

education

Lack of decision-

making power

Jorg

e M

ore

iro

Inadequate Attention to Adolescent Reproductive Health

70%

Percentage of

Ugandan women

who experience

their first pregnancy

by the age of 19

REDUCE… a Model on

Maternal Health and Survival

Reduce Model

Data on Maternal Health

Estimating the Consequences of Poor Maternal Health

Impact on Survival and Productivity (2001-2010)

REDUCE: Data Used

Uganda 1995 Demographic and Health Survey

WHO Global Burden of Disease

Uganda Safe Motherhood Costing Study

1991 Demographic Projections

Sexual and Reproductive Health Minimum Package

Other local literature and surveys

Survival

Maternal Deaths (2001-2010)

61,000 Maternal Deaths!

Jorg

e M

ore

iro

Infant Deaths per 1000 Life Births (Bangladesh)

Infant Deaths/1000 Life Births

Infant Deaths Resulting from Maternal Deaths

40,000 Infant DeathsJorg

e M

ore

iro

65%

Infant Deaths Resulting from Maternal Poor Health During Pregnancy

65%

Neonatal Tetanus: 38,000 Infant Deaths

Maternal Iodine Deficiency: 31,000 Infant Deaths

Maternal Malaria and Anemia: 220,000 Infant Deaths

Maternal Deaths (2001-2010)

61,000 Maternal Deaths!

Jorg

e M

ore

iro

Older Children

Orphaned Children

More

vulnerable

to

rights

violations

Disabilities

1 Woman Dies


20-30 Women Suffer Short and Long Term Disabilities


110,000 women will become infertile 1,200,000 women will suffer:

Inability to breastfeed Anaemia Incontinence due to fistulae Chronic pelvic pain Emotional depression Physical weakness Reduced productivity

(2001-2010)

Economic Consequences

Present Value of Productivity Losses

47353400 million US $

(2001-2010)

Iodine Deficiency during PregnancyU

NIC

EF

/C-7

9-39

Iodine is necessary for the normal development of the baby’s brain during pregnancy

Iodine Deficiency during PregnancyU

NIC

EF

/C-5

6-19

/Mur

ray-

Lee

Translates into reduced

Learning ability

School performance

Retention rates

in School-Age Children

Permane

Permane

nt!nt!

Present Value of Productivity Losses

47353400

million US $

(2001-2010)

408808

Recommendations

Three Delays

Delay in deciding to

seek appropriate care

Delay in reaching a

treatment facility

Delay in receiving

adequate treatment

at the facility

UNICEF/C-55-10/Watson


1200

506

280250230

0

200

400

600

800

1000

1200


Source: UNFPA, 1999

Maternal Deaths/100,000 Life Births


792

334280250230

0

200

400

600

800

1000

1200


Source: UNFPA, 1999


The Six Pillars of Safe Motherhood in Uganda

Safe MotherhoodSafe Motherhood

Fam

ily P

lann

ing

A

nte-

Nata

l Car

e

O

bste

tric

Care

P

ost-N

atal

Car

e

P

ost-A

borti

on C

are

S

TD-H

IV C

ontro

l

1. Family Planning

Increase number service delivery points

Encourage adolescents to delay first pregnancy

Encourage couples to space births

Update service providers’ skills:

Contraceptive technology

Counseling

2. Ante-Natal Care

Provide iron+folic acid supplements

Conduct immunization against tetanus

Conduct routine deworming

Provide presumptive treatment for malaria

Screen for risk factors

3. Skilled Obstetric Care at Birth

Increase the number of midwives

Update providers’ life saving skills

Monitor labor using a partograph

Provide essential obstetric care

Improve referral system

Mobilize ambulance/transportation services

Provide vitamin A supplement after delivery

4. Post-Natal Care

Identify and manage danger signs

Counsel and provide family planning services

Counsel on maternal nutrition during lactation

Promote good traditional social support

Conduct maternal mortality audits and review meetings

5. Post-Abortion Care

Train and equip personnel to offer MVA

Counsel and provide family planning services

Start prompt treatment for sepsis

6. STD/HIV Control

Offer voluntary testing and counseling

Screen pregnant women for syphilis

Manage cases and their complications

Continue and expand ongoing successful

prevention activities



Fam

ily P

lann

ing

A

nte-

Nata

l Car

e

O

bste

tric

Care

P

ost-N

atal

Car

e

P

ost-A

borti

on C

are

S

TD-H

IV C

ontro

l



Fam

ily P

lann

ing

A

nte-

Nata

l Car

e

O

bste

tric

Care

P

ost-N

atal

Car

e

P

ost-A

borti

on C

are

S

TD-H

IV C

ontro

l

Communication for Behavior Change


P r i m a r y H e a l t h C a r eP r i m a r y H e a l t h C a r e


Fam

ily P

lann

ing

A

nte-

Nata

l Car

e

O

bste

tric

Care

P

ost-N

atal

Car

e

P

ost-A

borti

on C

are

S

TD-H

IV C

ontro

l



E q u i t y a n d E d u c a t i o n f o r W o m e nE q u i t y a n d E d u c a t i o n f o r W o m e n

P r i m a r y H e a l t h C a r eP r i m a r y H e a l t h C a r e


Fam

ily P

lann

ing

A

nte-

Nata

l Car

e

O

bste

tric

Care

P

ost-N

atal

Car

e

P

ost-A

borti

on C

are

S

TD-H

IV C

ontro

l


Benefits of Action


1200

506

280250230

0

200

400

600

800

1000

1200


Source: UNFPA, 1999



792

334280250230

0

200

400

600

800

1000

1200


Source: UNFPA, 1999


Program Implementation 2001-2010

Percentage Reduction in MMR

Year of Implementation

Benefits of Action

Estimated for: Better ante-natal care Better obstetric care Reduction of:

Malaria Anaemia Iodine deficiency

Not Estimated for: Better neonatal care Better family planning Reduced incidence of STDs/HIV

Lives Saved and Disabilities Averted

12,500 lives of women

60,000 lives of children253,000 women spared from

disability

(2001-2010)

Productivity Gains

90 million US $

(2001-2010)

Conclusion

Women’s Right to Life and HealthU

NIC

EF

90-0

70/L

emoy

ne

Thousands of lives of

women and children

saved

Large increase in

women’s productivity

and income generating

ability

Four Conditions are Needed:

1. A strong

commitment to

maternal health

and survival by our

political leaders

and decision

makers


2. A clear focused

national

maternal health

and survival

strategy


3. A realistic,

appropriate, and

sufficient investment

in the maternal

health and survival

strategy


4. An implementation

framework with clearly

defined supervision,

monitoring, and

evaluation

mechanisms

Uganda,

“An Inspirational African Success Story in the Fight against HIV/AIDS”

Commitment Strategy Investment Implementation

Uganda can

Lead the

Fight against

Maternal

Death and

Disability

Enable Ugandan Women to …

Fully enjoy their rights

Fully contribute Uganda’s

Social

Economic, and

Political Development

JHU

/Ph

oto

Sh

are

Thanks for Your Attention

The REDUCE analysis in Uganda was undertaken under the leadership of the Ministry of Health, Reproductive Health Division, in collaboration

with:

The Regional Center for Quality of Health Care The Commonwealth Regional Health Community Secretariat The Makerere University, Dep. of Obstetrics and Gynecology The Makerere University, Dep. of Women and Gender Studies The Institute of Public Health, Makerere University, The Mukono District Health Team

with support from USAID’s Africa Bureau through the SARA Project and

USAID’s Global Bureau through the Quality Assurance Project

Ominde J. Achola, Commonwealth Regional Health Community Secretariat (ECSA)

Grace Bantebya-Kyomuhendo, Makerere University, Dep. of Women and Gender Studies

Dan Kaye, Mulago Hospital Dept. of Obstetrics and Gynecology

Essau. F. Katumba, Ministry of Health

Sarah Katumba , Mukono District Health Team

Sarah Kibuka, Commonwealth Regional Health Community Secretariat (ECSA)

Florence M. Mirembe, Makerere University, Dep. of Obstetrics and Gynecology

Michael Mubiru, Makerere University,

Edirisa Musisi, Mukono District Health Team

Twaha S. Mutyaba, Mulago Hospital, Dep. of Obstetrics and Gynecology

Susan W. Wandera , Mukono District Health Team

Christine Zirabamuzaale, Institute of Public Health

Joachim M. Zziwa, Mukono District Health Team

Produced by the REDUCE Team in Uganda

Documents

M aternal S urvival and H ealth A P athway to D evelopment in U ganda