Keynote Speech by Minister Manto Tshabalala-Msimang on the occasion of the seventh Annual Congress of Midwives of South Africa, Durban

Programme Director
Ladies and Gentlemen

Let me take this opportunity to thank the organisers of this the seventh Annual Congress of Midwives of South Africa for extending the kind invitation to me to deliver the keynote address this morning. I would also like to congratulate you on winning the bid to host the 29th Triennial Congress of the International Federation of Midwives (ICM) for 2011.

Let me also welcome the delegates from outside South Africa who are attending this Congress. You will not be disappointed by the friendliness, hospitality of the people and the beauty of Durban. I hope that you have had or you will have the opportunity to tour the province of KwaZulu-Natal during your visit here. I am very excited by the theme you have chosen for this congress which is midwives accelerating the attainment of the Millennium Development Goals (MDGs).

This will relate particularly to the Millennium Development Goal number five which is focuses on improving maternal health. The country's process towards attaining the MDGs is in motion and midwives are important role-players in this regard. Healthcare providers in general and midwives in particular, have an exceptional role to play in the endeavour to attain the MDGs especially:

* MDG four: Reducing child mortality through reducing by two thirds, between 1990 and 2015, the under-five mortality rate
* MDG five: Improving maternal health through reducing by three quarters between 1990 and 2015, the maternal mortality ratio.

In October this year, I attended the Women's Conference in London which was aimed at celebrating the 20th anniversary of the Safe Motherhood conference that was held in Nairobi, Kenya in 1987. The delegates were reminded that:

"More than half a million women die each year during pregnancy and childbirth. Most of them die because there is not enough skilled, regular and emergency care. In sub-Saharan Africa, one in 16 women run the risk of dying during pregnancy or childbirth over a lifetime, compared with about one in 2 800 women in the developed world."

Herein lies the challenge. There is no doubt that there are number of underlying factors that continue to undermine the health of women in Africa and limit their ability to have safe pregnancies and delivery. The challenge of poverty and under development, poor nutrition, lack of access to safe water and sanitation are some of the social determinants of health that have to be addressed if we are to significant reduce maternal deaths and under five mortality.

To achieve these goals, we also need dedicated commitment of each and every midwife in South Africa that we can hope to assure pregnant women in South Africa that they will deliver a healthy baby and be in good health to look after that baby after delivery.

The participants in this Midwives Congress aim to share experiences and ideas and commit to improving and maintaining high standards of midwifery practice. Maintaining those standards usually comes with a need to sacrifice. The women of Southern Africa primarily depend on you and your skills to ensure that their pregnancies are joyful journeys with happy destinations.

Let me hasten to refer to some of the eight congress themes you have chosen for this congress:

1. Saving mothers and saving babies: current status in South Africa and Africa. The confidential enquiry into maternal deaths process, now 10 years in operation, identifies the numbers, causes and avoidable or remediable factors associated with maternal deaths. As you discuss these processes during the congress, please commit to revert to your constituencies with the key messages that came out of the "Beyond the Numbers" A World Health Organisation (WHO) document which formed part of the conceptual framework of the South African National Committee on Confidential Enquiry into Maternal Deaths (NCCEMD).

Stated in this document are the following:

* avoiding maternal deaths is possible, even in resource-poor countries, but it requires the right kind of information on which to base programmes
* knowing the level of maternal mortality is not enough; we need to understand the underlying factors that led to the deaths
* each maternal death or case of life-threatening complication has a story to tell and can provide indications on practical ways of addressing the problem
* a commitment to act upon the findings of these reviews is a key prerequisite for success.

These abovementioned four key messages should be your "guiding stars" as you engage each other in constructive deliberations on saving mothers and saving children.

2. Empowering midwives: the skilled attendants

To be skilled and to remain skilled involves a conscious effort on the part of every cadre of healthcare provision in our respective health systems. Keeping up with the best practices in the profession, demands that all midwives avail themselves for continuing nursing education, self development and constant reading.

Nurses including midwives form the backbone of all the skilled birth attendants (inclusive of doctors and other birth attendant categories) in our health system. That is the reason for starting with nurses in the Occupation Specific Dispensation (OSD) initiative of the Department of Health. This will hopefully address the ever-growing challenge of attracting into and retaining nurses, in the public service.

3. Protecting the mothers, the neonate and the midwives physically, emotionally and psycho-socially

While protecting mothers and children, midwives like all other health workers deserve to feel secure in their working environments. Government is cognisant of the challenges that have confronted health workers with regard to security in some of the health facilities. Health facilities are valuable institutions that should remain accessible to the public at all times. All communities must therefore assist in protecting these institutions from crime. Crime is a social challenge which requires an integrated community response.

The Department of Health is also developing the standards for package of security services which should guide the provision of security services in health facilities.

4. Midwives holding hands with women, men, families and communities within the different cultural settings (Batho Pele). We should all respect the principle that "The users of our services should enjoy priority attention". Such principle underpins our African cultural being. It is also in line with the commitments we made through the Patient Rights Charter and the Batho Pele service principles. May I wish you insightful and fruitful deliberations in this regard?

Programme Director; let me reiterate what I said on the occasion of the Excellence in HealthCare Awards 2007 on 30 November 2007, at Vodaworld in Midrand. The protracted industrial action by government employees had serious impact and implications on the health sector. Healthcare providers including midwives suffered the most and were subjected to various forms of intimidation. You have to be once again commended for your continued service under those trying circumstances even though at times, it bordered on exposing yourselves to personal danger.

These are the challenges that need serious and frank discussion during this congress and devising possible strategies, geared towards avoiding a repetition in future. It is your constituencies that need to go back to the founding principles that guided the profession of nursing and to try to find ways and means of learning from these unfortunate experiences.

Ethical behaviour should at all times trump any other consideration when dealing with your clients especially pregnant women. Anything short of ethical conduct cannot and will not help to attain the MDGs four and five as expressed in the congress aims for 2007.

2007 is midway to the time-frame set in the United Nations Millennium Declaration, adopted by the eighth Plenary Session of the General Assembly on 8 September 2000. Let us use this opportunity to recommit ourselves to taking all measures possible to ensure that we honour our commitment and attain the MDGs.

Thank you.

Issued by: Department of Health
11 December 2007