Kenyan parliamentarians have been meeting in Nairobi since Monday to discuss how they can best support the improvement of women’s and children’s health.
The meeting dubbed ‘Parliamentary Retreat on Maternal, Newborn and Child Health’ is jointly hosted by the Kenyan Parliament and the Inter-Parliamentary Union, the global organisation of parliaments.
The meeting comes amidst growing concern about the state of the health of women and children in Kenya. The UN notes that rates of both maternal and child mortality have increased between 1990 and 2008. The child mortality rate has gone from 105 deaths per 1,000 live births to 128 deaths per 1,000 live births.
The maternal mortality rate has increased from 380 to 580. The lifetime risk of maternal death in Kenya in 2008 was 1 in 39, among the highest in the world.
However, Kenya is taking the right steps to mitigate this problem. In September 2010, at the Launch of the United Nations Secretary General Ban Ki-Moon’s Global Strategy for Women’s and Children’s Health, the Kenyan government committed to “recruit and deploy an additional 20,000 primary care health workers; establish and operationalise 210 primary health facility centres of excellence to provide maternal and child health services to an additional 1.5 million women and 1.5 million children” and to expand community health care.
The meeting of parliamentarians this week will discuss how these and other government policies and programmes can be funded and implemented in order to bring about tangible improvement in the health of women and children.
Farah Maalim, Deputy Speaker of the National Assembly said; “The new constitution of Kenya declares health as a basic right for all Kenyans. Parliament has a pivotal role to play in ensuring the realization of this right. As parliamentarians we are committed to taking legislative, budgetary and programme oversight actions required for essential health services to be accessible to all citizens. Unless parliament plays these critical functions, progress in securing the health of our women and children will not be made.”
Martin Chungong, the Director of the Programme for the Promotion of Democracy at the IPU said: “Improving the health of women and children requires countries to allocate adequate funding, develop effective national laws and implement the required programmes to improve the delivery of health services to all who require them. These are challenging but achievable priorities. Parliaments are strategically positioned and constitutionally mandated to ensure the achievement of these priorities and, ultimately, to ensure the health of women and children.”
“Under the auspices of the IPU, the global parliamentary community has made its commitment to contribute to the last push to ensure the achievement of health related Millennium Development Goals by 2015. The IPU is committed to assisting national parliaments to contribute to this global effort” said Chungong. The parliamentary retreat in Kenya will be followed by a similar parliamentary retreat on women’s and children’s health in Uganda.
Regionally, the African Speakers of Parliaments recently adopted a resolution on a Declaration of Commitment to prioritize parliamentary support for increased policy and budget action on Maternal, Newborn and Child Health in African countries. This comes a year after the Pan African Parliament (PAP), which is the legislative arm of the African Union, and the African Union Assembly of Heads of States, adopted declarations in support of women’s and children’s health.
Other stakeholders affirm the importance of the contribution of parliaments. Pius Okong, a Board member of The Partnership for Maternal, Newborn &Child Health said, “The role of parliamentarians in improving the accountability of the different actors is undeniable. In the last push towards 2015 it will be important for parliamentarians exercise their roles and for partners to support them in their initiatives.”
According to the UN, globally, 7.6 million children under the age of five and 358 000 women die every year. Sub-Saharan Africa has the highest maternal mortality ratio with women facing a 1 in 31 risk of dying due to pregnancy compared with women in industrialized countries which have a 1 in 4300 risk. The sub-continent also has the highest child mortality rates with 1 in 8 children dying before age five, more than 20 times the average for industrialized countries (1 in 167).
Most maternal and child deaths can be prevented by making available a set of effective interventions. For instance if births are attended by skilled health workers with the right supplies, equipment, support and supervision, most maternal deaths, caused mainly by haemorrhage, can be avoided. The leading causes of child deaths, pneumonia and diarrhoea, could be minimized by making antibiotics for pneumonia and oral rehydration therapy for diarrhoea, available.
African commitments to the UN Secretary-General’s Global Strategy for Women and Children’s Health by East African Countries
Burundi commits to increase the allocation to health sector from 8percent in 2011 to 15percent in 2015, with a focus on women and children’s health; increase the number of midwives from 39 in 2010 to 250, and the number of training schools for midwives from 1 in 2011 to 4 in 2015; increase the percentage of births attended by a skilled birth attendant from 60percent in 2010 to 85percent in 2015.
Burundi also commits to increase contraception prevalence from 18.9percent in 2010 to 30percent; PMTCT service coverage from 15percent in 2010 to 85percent with a focus on integration with reproductive health; and reduce percentage of underweight children under-five from 29percent to 21percent by 2015.
Congo commits to reducing maternal mortality and morbidity by 20percent by 2015 including obstetric fistula, by introducing free obstetric care, including free access to caesarean sections. Congo will also establish a new observatory to investigate deaths linked to pregnancy; and will support women’s empowerment by passing a law to ensure equal representation of Congolese women in political, elected and administrative positions.
The Democratic Republic of Congo (DRC) will develop a national health policy aimed to strengthen health systems, and will allocate more funds from the Highly Indebted Poor Country program to the health sector. DRC will increase the proportion of deliveries assisted by a skilled birth attendant to 80percent, and increase emergency obstetric care and the use of contraception. The government will increase to 70percent the number of children under 12 months who are fully immunized; ensure that up to 80percent of children under five and pregnant women use ITNs; and provide AVRs to 20,000 more people living with HIV/AIDS.
Ethiopia will increase the number of midwives from 2050 to 8635; increase the proportion of births attended by a skilled professional from 18percent to 60percent; and provide emergency obstetric care to all women at all health centres and hospitals. Ethiopia will also increase the proportion of children immunized against measles to 90percent, and provide access to prevention, care and support and treatment for HIV/AIDS for all those who need it, by 2015. As a result, the government expects a decrease in the maternal mortality ratio from 590 to 267, and under-five morality from 101 to 68 (per 100,000) by 2015.
Kenya will recruit and deploy an additional 20,000 primary care health workers; establish and put into operation 210 primary health facility centres of excellence to provide maternal and child health services to an additional 1.5 million women and 1.5 million children; and will expand community health care, and decentralize resources.
The Government of Lesotho is committed to meeting the Abuja Declaration Target of 15percent expenditure for health, compared to the current 14percent expenditure. The Government abolished user fees for all the health services at Health Centre level, while it has standardized user fees at hospital-level. The country has developed the National Health Sector Policy and its Strategic Plan which puts women and children at the centre.
The National Reproductive Health Policy and its Strategic Plan also focus on women and children. These documents have been disseminated and their implementation is closely monitored. The Reproductive Health Commodity Security Strategy is in place and ensures that 90percent of the women and men in the reproductive age group have access to commodities. The Lesotho Expanded Programme on Immunization Policy has been disseminated in 2010, focusing on under-five children. The Infant and Young Child Feeding Policy focuses on nutrition of children.
Rwanda commits to increasing heath sector spending from 10.9percent to 15percent by 2012; reducing maternal mortality from 750 per 100,000 live births to 268 per 100,000 live births by 2015 and to halve neonatal mortality among women who deliver in a health facility by training five times more midwives (increasing the ratio from 1/100,000 to 1/20,000). Rwanda will reduce the proportion of children with chronic malnutrition (stunting) from 45percent to 24.5percent through promoting good nutrition practices, and will increase the proportion of health facilities with electricity and water to 100percent.
The Republic of South Sudan commits to increase the percentage of government budget allocation to the Ministry of Health from 4.2percent to 10percent by 2015; to increase the proportion of women delivering with skilled birth attendants from 10percent- 45percent, through the construction of 160 Basic Emergency Obstetric Care facilities by 2015 and training of 1,000 enrolled/registered midwives by 2015; and to establish 6 accredited midwifery schools or training institutions/colleges; increase the contraceptive prevalence rate from 3.7percent to 20percent, and increase the percentage of health facilities without stock-out of essential drugs from 40percent to 100percent.
South Sudan also commits to reduce the prevalence of underweight among children under five from 30percent to 20percent; increase the percentage of fully-immunized children from 1.8percent to 50percent; and increase the percentage of under-fives sleeping under bed nets from 25percent to 70percent.
Finally, South Sudan will develop and implement a range of national policies that will strengthen its response to women and children’s health, including policies on national family planning, on provision of free reproductive health services, especially Emergency Obstetric care services, on decentralization of budgeting, planning, management of health services, and on adolescent sexual and reproductive health and rights.
Sudan commits to increase the total health sector expenditure from 6.2percent in 2008 to 15percent by 2015. Sudan commits to guarantee immediately free universal access to Maternal and Child Health (MCH) services including Immunization, Integrated Management of Neonatal and Childhood Illnesses (IMNCI), Nutrition, Antenatal Care (ANC), delivery care, post-natal care, and child spacing services to target all women and children.
Sudan also commits to train and employ at least 4,600 midwives focusing on states with the highest maternal mortality ratios and the lowest proportion of births attended by trained personnel. This will increase the percentage of births attended by trained personnel from 72.5percent to 90percent, increase quality universal access to Comprehensive Emergency Obstetric and Neonatal Care, and advocate for the elimination of harmful traditional practices like early marriage and Female Genital Mutilation/Cutting.
Tanzania will increase health sector spending from 12percent to 15percent of the national budget by 2015. Tanzania will increase the annual enrolment in health training institutions from 5000 to 10,000, and the graduate output from health training institutions from 3,000 to 7,000; simultaneously improving recruitment, deployment and retention through new and innovative schemes for performance related pay focusing on maternal and child health services.
Tanzania will reinforce the implementation of the policy for provision of free reproductive health services and expand pre-payment schemes, increase the contraceptive prevalence rate from 28percent to 60percent; expand coverage of health facilities; and provide basic and comprehensive Emergency Obstetric and Newborn care.
Tanzania will improve referral and communication systems, including radio call communications and mobile technology and will introduce new, innovative, low cost ambulances. Tanzania will increase the proportion of Children fully immunized from 86percent to 95percent, extend PMTCT to all RMNCH services; and secure 80percent coverage of long lasting insecticide treated nets for children under five and pregnant women.
Tanzania will aim to increase the proportion of children who are exclusively breast fed from 41percent to 80percent.
Uganda commits to ensure that comprehensive Emergency Obstetric and Newborn Care (EmONC) services in hospitals increase from 70percent to 100percent and in health centres from 17percent to 50percent; and to ensure that basic EmONC services are available in all health centres; and will ensure that skilled providers are available in hard to reach/hard to serve areas.
Uganda also commits to reduce the unmet need for family planning from 40percent to 20percent; increase focused Antenatal Care from 42percent to 75percent, with special emphasis on Prevention of Mother-to-Child Transmission (PMTCT) and treatment of HIV; and ensure that at least 80percent of under five children with diarrhoea, pneumonia or malaria have access to treatment; to access to oral rehydration salts and Zinc within 24 hours, to improve immunization coverage to 85percent, and to introduce pneumococcal and human papilloma virus (HPV) vaccines.
Chungong (L) peruses through the programme with Sue Mbaya/COURTESY