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More on Maternal Mortality
The Task Force on Child Mortality and Maternal Health opines that the MDG targets regarding both of above are attainable but not without extraordinary effort. It elaborates that though the technical interventions for achieving these Goals exist; they must now be implemented at a scale and in a manner that will reach those who need them most. Access to safe, effective, and affordable interventions must be provided to all, through efficient functioning of health systems; barriers to the utilization of competent, professionally delivered services must be lowered or eliminated. Certain key recommendations made by it for Health Systems in general and with specific reference to maternal health are mentioned below.
Health systems, particularly at the district level, must be strengthened and prioritized
in strategies for reaching the child health and maternal health Goals. Doing so demands a radical shift in the way health systems are addressed:
- Health systems must be understood not only as mechanisms for delivering technical interventions but also as core social institutions that are indispensable for reducing poverty, social exclusion, and inequity and advancing democratic development and human rights.
- For health systems to increase inclusion and close the equity gap, policies implemented in the context of good governance must:
- Strengthen rather than undermine government legitimacy.
- Prevent excessive segmentation of the health system.
- Increase the power of the poor and other marginalized groups to
- Make claims for healthcare
Strengthening health systems will require considerable additional funding.
- To progress at the speed required to meet the Goals in the poorest countries, both bilateral donors and international financial institutions must vastly increase foreign assistance to the health sector for the foreseeable future.
- User fees at the primary care level should be abolished; health system financing should not be an additional burden on the already impoverished populations.
- Countries should be encouraged to shift additional funds into the social sectors, to the extent possible.
The health workforce must be developed according to the goals of the health system,
with the rights and livelihoods of healthcare workers addressed. These principles must also inform strategies to address brain drain, low morale, and loss of productivity due to illness and death (often from HIV/AIDS), factors that are limiting the ability of governments to provide their populations with access to good-quality healthcare.
¡ Effective management and operational systems that seek to improve quality and increase trust in the health system should accompany the development of the health workforce.
¡ Medium to long-term plans for building a cadre of skilled birth attendants the health workers key to reducing maternal deaths must form an explicit part of all health workforce plans.
¡ 'Scope of profession' regulations and practice must be changed to empower mid-level providers, including skilled birth attendants to perform life-saving procedures safely and effectively.
Sexual and reproductive health and rights are essential to meeting all the Goals,
including those on child health and maternal health.
- Countries should take steps to ensure universal access to sexual and reproductive health services.
- Initiatives addressing the HIV/AIDS pandemic should be integrated with sexual and reproductive health and rights programs.
- Adolescents must receive explicit attention with services that are sensitive to their increased vulnerabilities and designed to meet their needs.
- In circumstances where abortion is not against the law, such abortion should be safe. In all cases women should have access to quality services for the management of complications arising from abortion.
- Governments and other relevant actors should review and revise laws, regulations, and practices, including on abortion, that jeopardize women's health.
Maternal mortality strategies should focus on building a functioning health system that ensures access to emergency obstetric care for all women who experience complications.
- The system should supply, support, and supervise the skilled birth attendants who should be the backbone of that system, whether they are based in facilities or in communities.
- Strategies to ensure skilled attendants for all deliveries must be premised on integration of the skilled attendant into a functioning district health system.
- Skilled attendant strategies cannot be allowed to substitute for strategies to strengthen the health system, including emergency obstetric care.
Information systems are an essential element in building equitable health systems.
- Indicators of health system functioningincluding equitymust be developed alongside disease- specific indicators and then integrated into policy and budget cycles.
- Health information systems must able to provide appropriate, accurate, and timely information that is used to inform management and policy decisions.
- Countries must take steps to strengthen vital registration systems.
It also recommends certain additons to targets and indicators of this MDG. Firstly, it mentioned that 'Coverage of emergency obstetric care' should added as one of the indicators and 'Universal access to reproductive health services' should be added as a new target.
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