MUSHI MATJILA: Why more investment in public health is crucial for pregnant women and newborns
Somewhere in the world a pregnant woman or newborn dies every seven seconds. In African countries the situation is even more dire. The tragedy is that it is often preventable. High blood pressure that is not detected and treated earlier, a delay in getting transport to hospital, a ventilator that’s not working properly or a shortage of medicines, could mean the end of a life.
The way mothers, newborns and children are looked after within the healthcare system has a profound effect on families and the broader community. Yet with inequity in access to health care and a fragmented healthcare system, they do not always get the urgent and quality care and treatment they need.
On the African continent and in SA the maternal mortality ratio, stillbirth, neonatal and under-five mortality rates are among the worst in the world. The UN estimates that in 2021 the mortality rate in SA was 32.8 per 1,000 children aged five and under. Many deaths occur in the first few weeks after birth, while many pregnant mothers die of conditions that are treatable if only they are given the right care at the right time.
The National Health Research Committee, which advises the health minister, has outlined ways to change this situation through high-quality healthcare and life-saving interventions. It also highlights why investment in emergency obstetric care, antenatal care and newborn care is vital and lays out the steps needed for policy reform and change within hospitals and clinics.
The main complications accounting for most maternal deaths are severe haemorrhage, infections, high blood pressure during pregnancy (pre-eclampsia and eclampsia) and complications during childbirth.
For newborns, the most common causes of death are asphyxia (which occurs when a baby does not get enough oxygen before, during or after birth), prematurity, foetal growth restriction and infections. Some, such as HIV, can be transmitted from the mother. Among other conditions these have been earmarked as focus areas for research.
Over the past few years the rollout of antiretrovirals has halved the number of deaths related to HIV infections, such as TB and pneumonia, among pregnant mothers. This excellent progress needs to be replicated in other areas.
There are practical things we can do, starting in the community and local clinic. We need a good referral system so that mothers get the care and medication they need. Apps such as the Vula app and other novel referral mechanisms that facilitate communication between clinicians at various levels and sites, could speed up the process of getting a mother admitted to hospital. Community healthcare workers who make home visits have a crucial role to play as well.
Reforms need to focus on treating patients closer to where they live, while incentives should be considered to attract and retain skilled health workers in remote rural areas. Transport is key. Delays in getting a mother to a hospital from her home, or between health facilities, can be a matter of life and death. A dedicated ambulance service for maternal, neonatal and child health would help slice transit time.
Once in the hospital, setting and implementing clear team protocols is essential. When a woman goes into labour she needs to be monitored appropriately by a skilled birth attendant so that any threat to her life and the wellbeing of her baby is detected early and acted upon.
Infection prevention and control is important to reduce the risk of bacterial infections for newborn babies. Ensuring clean cord care, insisting on strict basic hygiene in labour wards and nurseries and ensuring antibiotics are available for newborns at risk, is vital. Promoting breastfeeding and “kangaroo” mother care, which has proved to improve oxygen saturation and stabilise the baby’s heart rate, should be encouraged in all hospitals.
It is essential to roll out a more sustainable healthcare system to ensure mothers and babies survive. This includes resolving problems around inadequate facilities or equipment in neonatal units, a shortage of neonatal intensive care unit beds with ventilators and inadequate management plans.
More broadly, an improved and efficient data capturing system would help inform researchers and policymakers about how we are tracking indicators and how much we are spending on maternal newborn and child health.
Both in SA and on a continental level, governments should prioritise investments, financing and budget allocations so we can reach the 2030 UN sustainable development goals that relate to maternal, neonatal and child health.
Health research also dovetails with the work of the SA Health Technologies Advocacy Coalition. Among its goals is to advocate for the government to adopt a prioritisation framework to ensure funding for health R&D is co-ordinated and key investments are aligned to locally relevant health research priorities.
SA has outstanding health workers and researchers. Despite often having to juggle the demands of being clinicians at the same time, they shed light on what is working and what needs to be done to ensure mothers and babies survive and thrive despite tough conditions and a tight squeeze on health budgets.
The value of research cannot be underestimated. It has the power to cascade into life-saving change for mothers and babies and guide the way for the future.
• Prof Matjila, head of the department of obstetrics and Gynaecology at the University of Cape Town, chairs the National Health Research Committee.
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