B Hlongwa: Midwifery-Obstetric Neonatal and Child Health Services
Conference

1 August 2007

Honourable guests
Ladies and gentlemen

As far back as 1994 the government identified maternal and child health as a
national health priority. This was in line with the Convention on the
Elimination of all Discrimination against Women, the resolutions of the 1993
Vienna Conference on Human Rights and also the Millennium Development Goals
(MDGs).

South Africa is classified as a developing country, but it still straddles
the extremes of opulence and poverty. These extremes are reflected in the
chances women have of enjoying a healthy pregnancy and a safe delivery. We are
aware of the fact that some of the factors that contribute to increased
maternal and infant mortality cannot be traced directly to the health sector.
However, we also acknowledge that as custodians of public health we have a
responsibility to ensure that those problems that are within our control are
addressed.

The approach that we have adopted towards maternal and child health is human
rights driven. But we have also come to realise that expenditure on maternal
and child health is actually an investment that has positive long term
consequences not only for the health system but for society as a whole.
Maternal health is conventionally seen as beginning with pregnancy, continuing
with child birth and ending in post natal care. I would like to suggest that
the period before pregnancy and before the decision to fall pregnant be
included in our vision of maternal health.

The health status of a woman before she falls pregnant is inextricably
linked to the health status she is likely to enjoy during the course of her
pregnancy and even beyond. This is especially relevant in Gauteng where we have
an increasing number of teenage pregnancies and these impacts heavily on the
health of young women who face specific health problems associated with early
and unplanned pregnancies.

We acknowledge that despite all the interventions that we have put in place
the maternal and child mortality rate continues to rise. The World Health
Organisation (WHO) in 2003 identified the following key causes of maternal
deaths:

* 25% severe bleeding
* 20% indirect causes
* 15% infections
* 13% unsafe abortions
* 12% Eclampsia
* 8% Obstructed labour
* 8% other indirect causes.

Programme Director,

The above statistics are more or less consistent with what we are also faced
with in Gauteng. These statistics fly in the face of the investments we make in
terms of budget allocations to programmes that seek to improve and preserve
women's health in our province. These statistics also fly in the face of the
fact that we are a province that is 97% urban with four tertiary hospitals and
policies that are progressive.

The figures indicate that 38% of maternal deaths in South Africa are due to
preventable causes. This is not because our mothers cannot access professional
care during pregnancy and childbirth. The overwhelming majority are
professionally attended, especially in Gauteng. What it does indicate is that
considerable numbers of mothers are dying because of inadequate care at our
health facilities. The causes of these deaths are known to healthcare managers
and professionals because we have been carefully monitoring and analysing the
patterns for several years.

Programme Director, in 2002 Gauteng reported 669 maternal deaths in 2002 to
2004 and 493 deaths for the period 1999 to 2001. That was an increase of 36%
among reported mortalities. This is higher than the national increase of 20%.
The reason for this could be attributable to a number of factors including
improved reporting, failing health system, or migration of seriously ill
mothers into the province.

Chris Hani Baragwanath Hospital for example, delivers an average of about 60
babies per day and 50% of these deliveries are indeed high risk cases. However,
the other 50% were low risk, meaning they should have been conducted at clinics
with Maternal Midwifery Obstetric Units. Uncomplicated pregnancies should be
perfectly safely managed at level one facilities. It is puzzling to note that a
number of level one hospitals in our province have a high percentage of
caesarean births.

Despite the urbanised population and the availability of relatively
sophisticated health facilities in the province, the pattern of primary causes
of maternal deaths is very similar to that of other provinces. The proportions
of deaths from the preventable causes, such as postpartum haemorrhage,
antepartum haemorrhage and anaesthesia, are no lower than elsewhere in the
country. This is cause for concern.

I believe we have some of the best facilities with good equipment. This puts
us in a better position to improve on the current maternal health outcomes. We
also have the highest concentration of experts who can put their expertise to
optimal use for the same good. We need to find ways to put our resources to
more effective use.

We need to utilise continuous professional development for both nurses and
doctors to combat this increase in maternal deaths. We must ensure that all
pregnant women, families and couples are prepared for pregnancy, childbirth and
contraception through education and community mobilisation activities.

We are proud of our efforts to manage HIV and AIDS more effectively through
antiretroviral treatment (ART) and believe that gains in this area will be
reflected in the maternal death rate. We should begin to see a drop in maternal
deaths caused by pre-existing health conditions and infections.

We have also set aside a budget of R13 million for Mother and Child Health
Programme in the current financial year. This figure excludes money that has
been allocated for similar programmes at hospitals and clinics throughout the
province. Establishment of a fully fledged Mother and Child Health Directorate
is indicative of our commitment to improve health outcomes for mothers and
newly born babies.

Programme Director,

I have spent a considerable amount of time outlining the challenges that we
face, it would therefore be an injustice not to highlight those areas where we
have made significant progress:

We have five hospitals that have been certified Baby Friendly, namely:

* Leratong Hospital, Dr Yusuf Dadoo, South Rand Hospital, Odi Hospital and
Jubilee Hospital. We also have nine clinics with Maternal Obstetric Units which
have also been certified as Baby Friendly. These clinics are Mohlakeng,
Bekkersdal, Lillian Ngoyi, Mofolo Community Health Centre (CHC), Itireleng CHC,
Nokuthela Ngwenya CHC, Sharpville CHC, Soshanguve CHC and Laudium CHC.
* These hospitals and clinics have been granted this status due to having met
stringent criteria such as 80% of staff having been trained on lactation
management.
* Hospitals that implement Kangaroo Mother Care have increased from 16 to 22 in
the past financial year. The following benefits have been accrued from
implementing Kangaroo Mother Care.
* Neonatal mortality rate has been reduced by eight percent.
* Average bed occupancy rate has been reduced and Average length of stay has
been shortened as the babies are being discharged when they weigh 1 700 grams
instead of 1 800 grams which was the case before the implementation of this
programme.
* staff morale has improved
* mothers are supported to care for their infants
* the basic antenatal care was successfully piloted in two districts Ekurhuleni
and West Rand:
* the results showed great improvement in antenatal care and plans are afoot
for roll out throughout the province.

Programme Director,

I will not be with you throughout your deliberations during this conference,
but I have full confidence in your commitment to ensuring that we move closer
to meeting the MDGs, especially those that impact directly on Maternal and
Child Health. I offer you my support in your quest to ensure that the health
system is strengthened and improved in order to meet the challenges we
currently face.

I thank you.

Issued by: Department of Health, Gauteng Provincial Government
1 August 2007