The African Union Continental Workshop to Harmonise/ Develop, and Institutionalise the Maternal, Newborn and Child Mortality Reviews ( including Mortality assessment tools )and accelerate the Implementation of Recommendations - towards meeting MDG 4 and 5.
13th -16th April 2008, Turffontein Conference Centre, Johannesburg
HE Advocate Gawanas-AU Commissioner of Social Affairs.
Ms Daisy Mafubelu-The Assistant Director General of WHO
Honourable MECs
HE Ambassador Gertrude Mongella President of the Pan African Parliament
Representatives of the UN Agencies and other international Organisations
Chairperson of the NCOP And Chairperson of the Health Parliamentary Portfolio Committee
Members of the South African Confidential Enquiries into Maternal Deaths
Distinguished senior officials
Members of the media
Ladies and Gentlemen
It is a pleasure for me to welcome you to South Africa for this very important workshop. This workshop provides an opportunity for us to share experiences and best practices and strategies on reducing the Maternal, Newborn and under 5 (years) mortality.
It is said that Maternal and Infant Mortality are the litmus test that often indicates the level of development of a country, region or continent. It is of great concern, therefore, that in some of our African countries, the Maternal, Newborn and Child mortality have not decreased significantly or even increased in some Member States of the African Union.
This realisation has inspired the African Union to launch this collaborative programme called - "Africa's Movement to improve Maternal Health and Promote Child Survival and Development in Africa".
The impact of the other broad determinants of health, like poverty, underdevelopment, low levels of literacy, lack of proper housing, water and sanitation and gender inequality continue to undermine the health of populations of Africa. There is a need to intensify multi-sectoral efforts to reverse the situation.
Society should not ignore the negative impact of the huge debt burden within which some Member States have to finance their health and social programmes aimed at reducing the death of women and children.
In addition, it must be acknowledged that not all the promises of the international community to assist developing countries have been fulfilled. It is still true today for example that a cow in the EU enjoys a higher subsidy than the incomes of more than half the world's population at $2.20 a day!
We also have to highlight the challenges posed by current high food prices which are certainly going to undermine the health status of our populations. It is necessary to continue to call for a fair trade arrangement between the north and the south particularly with regard to opening the market for African farmers to sell their products.
As we commemorate the 30 years of the Alma Ata Declaration which highlighted the importance of Primary Health Care, let us continue to strengthen the District Health system so as to improve access to quality health care services for all our communities. This will include strengthening of the referral chain and provision of emergency health care services for pregnant women, mothers and children where necessary.
This workshop is aimed at exploring ways of institutionalising mortality reviews. The review of the causes of these deaths is the best way of identifying weaknesses and gaps in our systems and be able to respond accordingly.
This meeting provides us with an opportunity to develop, simplify or harmonise the mortality assessment tools as part of a broad mortality review process that is critical for our continent. It is important that we improve the collection and management of data as part of our effort to monitor the performance of the health system.
It is anticipated that the outcome of this workshop will be an implementation plan for the broad strategies and interventions which you will decide on following the evidence based reviews of what has worked in some countries.
Programme Director, the Bureau of the Africa Union Ministers of Health appreciates the collaboration that has been forged with the development partners, particularly the Health related UN Agencies in the preparation for this workshop. The role played by the UNDP, WHO, UNICEF and UNFPA Regional Offices is greatly appreciated.
We are also grateful that these agencies have funded many of the experts that are supporting this conference and provided some conference material. The input of universities, research institutions and the Eastern and Southern African Health Community is also greatly appreciated.
In line with the Paris Declaration that mandates Development Partners to support country led plans and strategies, one hopes that the same enthusiasm and collaboration will continue. This will strengthen the sustained implementation of this continental initiative to improve Maternal and Child health and Survival and development in the African continent. Success will be realised if all organisations collaborate in implementing critical programmes in a sustainable way. It is my hope therefore that this collaboration will not end after the workshop but will continue into the implementation phase.
Programme Director, allow me to briefly share the happy occasion that South Africa is celebrating here today. It has been ten years since South Africa decided to embark on Confidential Enquiries Into Maternal Deaths (1997 to 2007) joining the United Kingdom which is the only other country that does similar reviews.
Every Maternal Death is notifiable by law. This process of confidential enquiries has helped us to identify some of the preventable causes and contributing factors to maternal deaths.
These range from the Community factors and delays, facility level factors related to management challenges as well as clinical care factors that relate, among others, to the quality of care.
Recommendations are made to address these challenges and this has enabled us to develop specific interventions to improve the quality of care for pregnant mothers at all the levels of care. We believe that it is because of this evidence based intervention that the Maternal Mortality ratio has reduced in the ten years to 124/100,000 live births from 150/100 000 live births in 1998.
Whilst we are aiming at greater reduction of this maternal Mortality ratio, we believe that it is a programme that we can share with sister countries who are interested in embarking on it. In fact a few countries have already expressed their interest in collaborating on this issue.
I would like to thank Prof Jack Moodley for chairing the Committee on Confidential Enquiries into Maternal Death over the past ten years.
I also would like to thank all the members of committee and the assessors who have all worked tirelessly in this area over the last ten years. Your efforts and continued commitment to improving the health of women and children is very much appreciated.
We do however still have a challenge of documenting all maternal deaths that occur outside health facilities. Recording such deaths requires close collaboration with the community and other players such as the Department of Home Affairs. We are looking forward to sharing experiences with the Members States that are doing these audits through Community Verbal Autopsies.
The other good effect of the Confidential Enquiry into Maternal Deaths is that professionals in research institutions and universities partnered with the Department of Health to do develop a Perinatal Problem Identification programme (PPIP) and more recently the Child Problem Identification Programme (CHIP).
These programmes have been helpful in identifying some of the weaknesses in the care of babies and children under five. We are in the process of institutionalising both programmes as a way of improving the quality of care to all the children in this country.
In Conclusion, I would like to encourage you to use the opportunity of this meeting to share and learn from each others best practice in the improvement of care for mothers, babies and children. The Ministers of Health keenly anticipate positive outcomes of this workshop which should be part of the progress report for the Heads of States on the implementation of the Africa Health Strategy.
I wish you fruitful deliberations.
Thank you for your attention.