Date: 19/09/2006
Source: Department of Health
Title: Tshabalala-Msimang: Maternal deaths Saving Mothers Report
Speech by the Minister of Health, M Tshabalala-Msimang, on confidential enquiries into maternal deaths in South Africa, Saving Mothers Report
It gives me great pleasure to address you this morning as we discuss the critical issue of the health of mothers in our country.
This is one of the groundbreaking works that we have been involved in as a country. I do not know of any other developing country that not only records maternal deaths, but goes on to investigates the causes with the aim of preventing these unfortunate incidents.
We should be confident as South Africans of the work we are doing in the health area, which unfortunately sometimes puts us in a negative light. We note, for instance, that the World Health Organisation (WHO) has finally endorsed indoor residual spraying using DDT as an important intervention in addressing the challenge of malaria. We have been the sole voice defending this intervention at an international level, despite the strong opposition and pressure to move away from this position.
We welcome the new position taken by WHO and will continue to use this intervention in a controlled manner to support our efforts to eliminate malaria in our region. I am sure we all appreciate the impact that malaria has on health particularly of pregnant women and children.
While we remain part of the global community, we should be confident and defend the positions we take as a nation in responding to our health challenges in a manner that is relevant to our local realities. Sometimes our approaches may not be popular amongst certain role players. But we need to remain focused on our conviction to improve the health of the people of our country and the continent.
When we attained our freedom, many laws and policies were put in place to improve the lives of the people of South Africa, including free health care for pregnant and lactating women and children under the age of six years. Regarding maternal health, the Choice on Termination of Pregnancy Act of 1996, notification of maternal deaths, as well as the confidential enquiries into the maternal deaths process are some examples of the policies that we introduced to improve the quality of life of the women of South Africa.
The implementation of the Choice on Termination of Pregnancy (CTOP) Act has had a positive impact on the lives of women. Access to termination of pregnancy services has improved remarkably. A study commissioned to evaluate the health impact of the CTOP Act of 1996 in 2000 showed that there was a significant reduction in morbidity from complications of incomplete abortion compared to a similar study conducted in 1994.
In addition, the confidential enquiries into maternal deaths indicate that there has been a reduction in deaths resulting from unsafe terminations of pregnancy. Before the implementation of this Act, it was estimated that 425 deaths occurred each year in public facilities from unsafe abortion. Deaths from unsafe abortion reported by the Saving Mothers' reports one and two (which covers Confidential Enquiry of 1998 and 2002) were 32 and 40 per respective years.
The policy on free health care services has had a positive impact on access to reproductive health services. About 94% of women attend antenatal care at least once during pregnancy and over 84% of women deliver in health care facilities. We have also made significant strides since we set up the confidential enquiries into the maternal deaths process. It is however of great concern that maternal mortality remains high in South Africa. This is particularly concerning as access to health care services does not seem to be a problem.
The questions we have to resolve are:
* Why then are numbers of maternal deaths still high when the majority of women access care?
* Where are we getting it wrong?
* Is this a reflection of lack of necessary skills on the part of our health care professionals?
* Or is it a reflection of lack of the essential tools to facilitate care by our health care professionals?
* Is it simply an attitudinal problem and lack of support for the health care professionals?
I am asking these questions because I could not get a clear answer, even from the avoidable factors, where we are missing the boat. I hope your deliberations will come up with strategies that will respond to some of these questions and facilitate the improved care of women. We should ensure that all women who present themselves for care in our facilities get the best care available. I am sure with your help and commitment we can achieve this.
We have to particularly address the point raised in the report that a significant number of deaths could have been avoided.
The report makes recommendations on how some of these challenges can be addressed. We need to consider these recommendations within our policy development processes and intensify efforts in rectifying any shortcoming that may be existing within the health care delivery system to prevent these incidents. We have to ensure that preventable deaths are eliminated within the health system.
We know that it is possible to reduce the magnitude of both maternal and perinatal morbidity and mortality in countries with limited resources. The report before us has assisted us to understand what is causing both perinatal and maternal deaths, as well as what needs to be done to improve the situation. The recommendations of the Saving Mothers report clearly indicate to us how the situation can be improved. For the first time, the Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) also provided us with strategies to facilitate implementation of these recommendations. We really appreciate your efforts in this regard.
Amongst us here are people responsible for the education and training of health professionals. As custodians of health education and training in our country, you need to discuss what changes in the health educational programmes are needed to bring about both the prevention of maternal deaths and the appropriate treatment of pregnant women with obstetric complications. How can we all join hands (the Department of Health and training institutions) to ensure continuing professional development of health care professionals in this field?
The Department of Health has already started conducting workshops with relevant managers in provinces. These workshops discuss the issues raised in the reports and identify interventions that have to be made at an operational level to prevent maternal deaths.
Colleagues, I have outlined some of our achievements and the challenges we face with maternal health care in South Africa. Most of these challenges can be overcome if we all intensify efforts at improving the quality of lives of women. I would like to thank all the members of the Committee on Confidential Enquiries into Maternal Deaths for all their hard work and for producing the latest Saving Mothers Report.
I would also like to express my gratitude to you all for making time to avail yourselves for this important activity. I wish you successful deliberations and hope the outcome of this workshop will help shape the education and training of our doctors, midwives and all other health workers involved in the delivery of maternal care. I hope you can come with means to enhance continuing professional development, which I believe is essential to improving the quality of care in our facilities.
With your support, we can indeed achieve our goal of improving the health of women and children.
Thank you
Issued by: Department of Health
19 September 2006
Source: Department of Health
Title: Tshabalala-Msimang: Maternal deaths Saving Mothers Report
Speech by the Minister of Health, M Tshabalala-Msimang, on confidential enquiries into maternal deaths in South Africa, Saving Mothers Report
It gives me great pleasure to address you this morning as we discuss the critical issue of the health of mothers in our country.
This is one of the groundbreaking works that we have been involved in as a country. I do not know of any other developing country that not only records maternal deaths, but goes on to investigates the causes with the aim of preventing these unfortunate incidents.
We should be confident as South Africans of the work we are doing in the health area, which unfortunately sometimes puts us in a negative light. We note, for instance, that the World Health Organisation (WHO) has finally endorsed indoor residual spraying using DDT as an important intervention in addressing the challenge of malaria. We have been the sole voice defending this intervention at an international level, despite the strong opposition and pressure to move away from this position.
We welcome the new position taken by WHO and will continue to use this intervention in a controlled manner to support our efforts to eliminate malaria in our region. I am sure we all appreciate the impact that malaria has on health particularly of pregnant women and children.
While we remain part of the global community, we should be confident and defend the positions we take as a nation in responding to our health challenges in a manner that is relevant to our local realities. Sometimes our approaches may not be popular amongst certain role players. But we need to remain focused on our conviction to improve the health of the people of our country and the continent.
When we attained our freedom, many laws and policies were put in place to improve the lives of the people of South Africa, including free health care for pregnant and lactating women and children under the age of six years. Regarding maternal health, the Choice on Termination of Pregnancy Act of 1996, notification of maternal deaths, as well as the confidential enquiries into the maternal deaths process are some examples of the policies that we introduced to improve the quality of life of the women of South Africa.
The implementation of the Choice on Termination of Pregnancy (CTOP) Act has had a positive impact on the lives of women. Access to termination of pregnancy services has improved remarkably. A study commissioned to evaluate the health impact of the CTOP Act of 1996 in 2000 showed that there was a significant reduction in morbidity from complications of incomplete abortion compared to a similar study conducted in 1994.
In addition, the confidential enquiries into maternal deaths indicate that there has been a reduction in deaths resulting from unsafe terminations of pregnancy. Before the implementation of this Act, it was estimated that 425 deaths occurred each year in public facilities from unsafe abortion. Deaths from unsafe abortion reported by the Saving Mothers' reports one and two (which covers Confidential Enquiry of 1998 and 2002) were 32 and 40 per respective years.
The policy on free health care services has had a positive impact on access to reproductive health services. About 94% of women attend antenatal care at least once during pregnancy and over 84% of women deliver in health care facilities. We have also made significant strides since we set up the confidential enquiries into the maternal deaths process. It is however of great concern that maternal mortality remains high in South Africa. This is particularly concerning as access to health care services does not seem to be a problem.
The questions we have to resolve are:
* Why then are numbers of maternal deaths still high when the majority of women access care?
* Where are we getting it wrong?
* Is this a reflection of lack of necessary skills on the part of our health care professionals?
* Or is it a reflection of lack of the essential tools to facilitate care by our health care professionals?
* Is it simply an attitudinal problem and lack of support for the health care professionals?
I am asking these questions because I could not get a clear answer, even from the avoidable factors, where we are missing the boat. I hope your deliberations will come up with strategies that will respond to some of these questions and facilitate the improved care of women. We should ensure that all women who present themselves for care in our facilities get the best care available. I am sure with your help and commitment we can achieve this.
We have to particularly address the point raised in the report that a significant number of deaths could have been avoided.
The report makes recommendations on how some of these challenges can be addressed. We need to consider these recommendations within our policy development processes and intensify efforts in rectifying any shortcoming that may be existing within the health care delivery system to prevent these incidents. We have to ensure that preventable deaths are eliminated within the health system.
We know that it is possible to reduce the magnitude of both maternal and perinatal morbidity and mortality in countries with limited resources. The report before us has assisted us to understand what is causing both perinatal and maternal deaths, as well as what needs to be done to improve the situation. The recommendations of the Saving Mothers report clearly indicate to us how the situation can be improved. For the first time, the Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) also provided us with strategies to facilitate implementation of these recommendations. We really appreciate your efforts in this regard.
Amongst us here are people responsible for the education and training of health professionals. As custodians of health education and training in our country, you need to discuss what changes in the health educational programmes are needed to bring about both the prevention of maternal deaths and the appropriate treatment of pregnant women with obstetric complications. How can we all join hands (the Department of Health and training institutions) to ensure continuing professional development of health care professionals in this field?
The Department of Health has already started conducting workshops with relevant managers in provinces. These workshops discuss the issues raised in the reports and identify interventions that have to be made at an operational level to prevent maternal deaths.
Colleagues, I have outlined some of our achievements and the challenges we face with maternal health care in South Africa. Most of these challenges can be overcome if we all intensify efforts at improving the quality of lives of women. I would like to thank all the members of the Committee on Confidential Enquiries into Maternal Deaths for all their hard work and for producing the latest Saving Mothers Report.
I would also like to express my gratitude to you all for making time to avail yourselves for this important activity. I wish you successful deliberations and hope the outcome of this workshop will help shape the education and training of our doctors, midwives and all other health workers involved in the delivery of maternal care. I hope you can come with means to enhance continuing professional development, which I believe is essential to improving the quality of care in our facilities.
With your support, we can indeed achieve our goal of improving the health of women and children.
Thank you
Issued by: Department of Health
19 September 2006
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