Up to 51 percent of births in sub-Saharan Africa take place without the presence of a midwife or skilled health worker. Every year, forty million mothers around the world give birth on their own. And every day, almost 18,000 children under the age of five die by preventable causes.
The numbers are staggering, and paint a picture of how despite claimed progress, much works remains to be done in addressing newborn and child mortality across the globe a year before the Millennium Development Goals expire.
One way of moving forward, according to international humanitarian organization Save the Children, would be to increase the number of skilled health workers, particularly in those countries where they are most needed.
At present, the World Health Organization and the Global Health Workforce Alliance estimate a shortage of 7.2 million around the world — a huge number that at the current annual progress rate of 1.1 percent is hard to meet, and could mean 354 million unattended births between now and 2043, the aid group said in a new report published on Monday.
The current rate lags behind the MDG 5 of 90 percent coverage by 2015, and Save the Children is calling on the international community to double its efforts to increase the current coverage by 2.3 percent a year to meet the goal by 2025.
Not just a staffing issue
But simply increasing the number of health workers in a given setting is not enough to ensure newborn survival. Statistics cited in the report support this: With 78,977 stillbirths and first-day deaths, the Democratic Republic of Congo has one of the highest newborn mortality rate across sub-Saharan Africa, despite enjoying a high rate of 80.4 percent of skilled attendance at birth.
So what’s the problem?
“It’s really about whether health workers are present, motivated, equipped and supported in a functioning facility and whether community members choose to use that facility. In many cases, there are simply not enough qualified health workers to go around,” Save the Children President and CEO Carolyn Miles told Devex.
There are a number of reasons for the lack of midwives, nurses and doctors in places where they are most needed, but mainly poor working conditions, few career opportunities, small wages or an unsafe environment. It doesn’t help that resources for health worker training programs also appear to be “limited.”
“There is a shortage of skilled educators who can train people in clinical methods, [and] medical training facilities are sometimes in short supply (e.g., schools of midwifery),” Miles explained.
Governments in need, according to the WHO, must increase their per capita spending on health care to $60. This is vital in recruiting, training, deploying, equipping and supporting the number of health workers needed to achieve the MDGs, said Miles, who argued: “In many cases, this will require a significant increase in the public sector wage bill and an overall increase in health spending by governments and donors.”
These actions will prove to be crucial this year, and organizations like Save the Children are all looking forward to May at the annual World Health Assembly in Geneva, where ministers will gather to discuss and hopefully commit to a new strategy to end preventable newborn deaths and stillbirths under a so-called “Every Newborn Action Plan.”
The plan targets to reduce by two-thirds current newborn mortality rates, and eventually, all newborn deaths by 2035 through a handful of proven, scalable and affordable interventions, such as the infamous Kangaroo mother care or skin-to-skin contact to keep premature babies warm without incubators.
What’s in it for aid groups and donors?
“Organizations focused on children should read in the plan the potential they have to contribute to the remaining challenge of newborn mortality, which is 44 percent of all under-five deaths. And donors should realize the potential for gains in this area and might need to consider investing in the training of health workers as a key intervention to save newborns, mothers and children,” Miles said.
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