Remarks of
Dr. Luis Gomes Sambo, Regional Director, WHO Regional Office for Africa, World
Health Summit - Berlin, Germany 11 October 2010
Your Excellencies Members of the Panel, Distinguished
Guests, Ladies and Gentlemen,
It’s a great honour and privilege to address this
august gathering of eminent personalities. I would like in particular to
express my profound gratitude to the organizers of the World Health Summit for
creating this unique forum.
The theme of this session ‘Accelerating towards Achieving
the Health MDGs 4 and 5’ is very pertinent at this particular point in time.
With about five years left before the endpoint of the Millennium Development
Goals, the slow progress in improving maternal and child health remains a
matter of global concern particularly in sub-Saharan Africa.
I would like to make a quick review of essential
interventions required to improve maternal and child health and the coverage of
these interventions; and then I will refer to current maternal and child
mortality trends and the health systems response to accelerate progress towards
MDGs 4 and 5.
Distinguished Guests, Ladies and Gentlemen,
Looking at the fourth Millennium Development Goal to
reduce child mortality by two thirds between 1990 and 2015, we see that the interventions
required to attain this goal are well known. The key to making progress
towards attaining this goal by 2015 is reaching every newborn and child with a
set of priority interventions. These interventions include: Appropriate
breast feeding and infant and young child feeding practices; prevention of
vaccine preventable diseases through effective immunization and prevention and
management of common childhood illnesses e.g. Pneumonia, diarrhea, malaria,
malnutrition and HIV infection.
Generally, interventions that can be routinely
scheduled and delivered, such as immunization, have much higher coverage than
those that rely on 24-hour availability of clinical services such as care of
sick children.
If we look at percentage of immunization coverage among
1-year old children for the third dose of Diptheria/ Pertusis /Tetanus (DPT3),
we note that this coverage has increased in the African Region from 57% in 1990
to 72% in 2008. Despite this increase, the coverage level remains below the
global average, which increased from 75% to 82% during the same period. The
African Region and South-East Asia have the lowest immunization coverage for
DPT3.
However, we find out that the access to new vaccines
such as rotavirus and pneumococcal that could significantly reduce under five
morbidity and mortality are not affordable to those who need them most. An
initiative to improve access to such vaccines could significantly contribute to
accelerate the pace towards MDG4.
When it comes to management of common childhood illnesses,
only about 37% of children with diarrhea receive life-saving oral re-hydration
therapy and only 43 percent of children with symptoms of pneumonia receive care
by skilled health workers.
Distinguished guests, Ladies and Gentlemen
As I said earlier, for most childhood illnesses, the
interventions for prevention and control are known but their coverage is
limited. As a result, sub-Saharan Africa has made the least progress in
improving child survival compared to all other regions in the world.
Global under-five mortality has reduced from 90 per
1000 live births in 1990, to 65 per 1000 live births in 2008. In the African
Region, the under-five mortality rate during the same period has dropped from
182 to 142, but remains the highest of any region in the world.
Child mortality in the African Region is currently
going down at an average rate of 1.4% per year. However, in order to meet the
fourth Millennium Development Goal, African countries need to reduce mortality
by at least 8% each year until 2015.
Currently, out of 46 countries in the region, only six
are estimated to be on track to achieve MDG4 (Botswana, Cape Verde, Eritrea,
Malawi, Mauritius and Seychelles). Twenty-seven are estimated to be making
insufficient progress, while the remaining thirteen are not making any progress
at all.
This situation calls for intensified support to scale
up the delivery of chid health interventions, which presupposes the
strengthening of health systems capacities at local level.
Distinguished guests, Ladies and Gentlemen,
Women play a crucial role in achieving sustainable
socio-economic development. Despite the availability of tools and knowledge to
protect women’s health, in the African region, women still face challenges in
terms of survival. Pregnancy that normally should end with a new healthy life
bringing untold joy to a mother, oftentimes results in tragic loss of life –
either of the mother, the child or both.
Proven cost effective interventions exist and vast
majority of maternal deaths could be averted if every woman had access to
quality reproductive health services. These include family planning and skilled
attendance during pregnancy, childbirth and the postnatal period. In addition,
there is a need to strengthen the capacity of individuals, families and
communities to improve their awareness, knowledge and behaviours towards
maternal and newborn health.
Generally, coverage of skilled birth attendance in the
region remains low at 47% with wide variation of the rates among countries.
Looking at some of the specific interventions, only 12% of pregnant women
requiring Emergency Obstetric Care actually receive it; and Caesarean Section
rate is only 3.4% compared with the Americas which has the highest rate
estimated at 31%. You will note that the global rate of Caesarean Section is
about 14%.
The low coverage of these life saving interventions in
the Africa Region has led to the highest maternal mortality rate in the world.
This rate has now reduced from 910 per 100 000 live births in 1990 to 620 in
2008. For every maternal death, there are at least thirty women who suffer
short- or long-term disabilities. The Maternal Mortality Ratio for other regions in
2008 was 320 for the Eastern Mediterranean, 240 for South-East Asia, 66 for the
Americas Region and 51 for West Pacific Region. The European region has the
least maternal deaths, standing at 21 per 100,000 live births. The overall
global rate is estimated to be 260 per 100,000 live births.
The decline of maternal mortality in sub Saharan
Africa over a 15 years period between 1990 and 2005 was only 0.1 per cent while
to achieve MDG 5 we need at least a 5.5% decline per year.
Distinguished Guests, Ladies and Gentlemen,
The achievement of MDG 6 on Malaria, HIV/AIDS and
Tuberculosis has great impact on maternal and child mortality rates
Malaria is responsible for 7% of under-five deaths
globally and 16% in the African Region. It is also an indirect cause of
maternal mortality and contributes to still birth, premature delivery and low
birth weight.
Globally, the 2 top causes of deaths in women in
reproductive age are HIV/AIDS (19%) and pregnancy related complications (15%). With
regards to HIV/AIDS in Sub-Saharan Africa, 60% of all people living with
HIV/AIDS are women. In 2008 alone, of all new HIV infections among children,
91% occurred in Africa and almost all result from mother to child transmission.
Looking at tuberculosis, globally almost 40% of new
cases in 2008 were women. Co-infection of HIV and Tuberculosis accounts for
over 25 % of deaths among women of reproductive age.
Now, I will refer to the impact of MDGs 1 and 7 on MDG
4 and 5. Starting with MDG1, there is evidence that malnutrition increases the
risk of maternal and child mortality. Moreover in the last two decades, the
high percentage of undernourished children remains unchanged, and this
partially explains the slow progress in achieving MDG4. Anaemia affects 57% of
pregnant women in Africa, raising the risk of premature birth,
low-birth-weight, haemorrhage and sepsis.
Regarding MDG 7, the percentage of the world’s
population using “improved” drinking water sources increased from 77% to 87%
between 1990 and 2008. This rate is sufficient to achieve the relevant MDG
target globally. In the WHO African region, however, while the percentage
increased from 50% in 1990 to 61% in 2008, it remained off-track for achieving
the MDG target.
In 2008, 2.6 billion people were not using “improved”
sanitation facilities. The situation was most severe in the African Region,
where the percentage of the population using improved sanitation facilities
increased very slowly: from 30% in 1990 to 34% in 2008.
The inadequate availability of clean water and
improved sanitation has a negative impact on incidence and prevalence of
childhood illnesses
Distinguished Guests, Ladies and Gentlemen
In the African Region, weak health systems have been a
hurdle to scaling-up coverage of essential health interventions. The renewed
focus Primary Health Care with its principles and values of social justice,
equity, solidarity, effective community participation and multi-sectoral
action, offers a sustainable approach to redesign national health systems in a
flexible manner to respond to maternal and child health needs.
Policy and governance should take into account aspects
of human rights, gender and equity as well as women’s empowerment. Health
policies and plans should prioritize maternal and child health. There is also
need to ensure that other areas of government policy and legislation promote
the health of mothers and children.
Countries should develop comprehensive health
financing policies.
Health care financing strategies including government
budget, international funding, social health insurance and out-of-pocket
expenditures need careful review and reforms.
The African Region continues to face a critical
shortage of human resources for health with only 2 Physicians/10,000 population
and 11 nursing & midwifery staff /10,000 population. An evidence-based
health workforce planning and monitoring as well as adequate training,
deployment, retention and career development is needed to address the current
human resources needs.
In relation to health technologies, there is a need
for a better access to quality and safe health technologies.
Improving generation of evidence and information is
also required for policy making, accountability, resource allocation and
performance.
In summary, Ladies and Gentlemen,
Progress on MDGs 4 and 5 could be improve by:
- Renewed national and international commitment and ad more effective leadership in health;
- Increased and sustained resources by governments and partners;
- Access to available new technologies the can positively impact maternal and child health;
- Efficient and effective use of resources at national level;
- Empowering communities and gender main streaming and
- Improved generation of evidence through information systems and research.
Distinguished Guests, Ladies and Gentlemen
I am confident that if we all pull together our
efforts, we will be able to make good health and well being a reality for the
millions of mothers and children that are still left behind.
We need to act now…for tomorrow is too late.
Thank you
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