“Despite significant progress made over the past few years, South Africa’s maternal mortality figures remain very high at 116.9 per 100 000,” says Sunet Jordaan, project manager, FPD – MSD for Mothers. Neonatal mortality rates are also unacceptably high at 9.9 per 1 000. It is estimated that 40% of all maternal deaths are avoidable and related to community, administrative and clinical factors.”
She says lack of ante-natal care, being pregnant when older than 35 or younger than 18, and inadequate and delayed transport to clinics and hospitals during distressed labour increases the risk of maternal mortality. “Another major concern is the number of babies born before arriving at a health facility, which constitutes 6.33% of all births. The World Health Organisation (WHO) target is 1.5% of all births, as birth before arrival increases the risks of neonatal mortality."
MSD for Mothers has established a 10-year, $500m global initiative to create a world where no woman dies giving life. In South Africa, MSD provided funding for the Foundation for Professional Development (FPD), a non-governmental organisation, to implement an obstetric emergencies training programme to improve maternal and infant survival by raising the quality of emergency care for pregnant mothers and newborn babies as they are transported by ambulance to health facilities. The programme is endorsed by the National Department of Health (NDoH), “The training of healthcare workers, specifically on the essential steps in managing obstetric emergencies (ESMOE) helps to reduce maternal deaths specifically related to obstetric haemorrhage, pregnancy related infections and complications of hypertension,” says Jordaan. “Research has shown that emergency drills, as conducted during ESMOE training, reduce maternal mortality in South Africa”.
Under the leadership of the FPD, the MSD for Mothers obstetric emergencies in South Africa programme is working to improve maternal and infant survival by improving the quality of emergency care provided to pregnant mothers and newborns during ambulance transit between health facilities. The project focuses on five health districts: Capricorn (Limpopo), Amathole (Eastern Cape), and Nkangala, Enhlanzeni and Gert Sibande (Mpumalanga).
“We anticipate that training and capacity building of EMS staff will enable them to better manage obstetric emergencies in transit and reduce the number of women dying from preventable causes related to pregnancy and childbirth,” says Jordaan. “The completed work has significant potential to have an immediate impact on maternal and perinatal deaths in South Africa and will directly contribute to the NDoH’s longer-term strategy to strengthen obstetric EMS systems.”
In an unprecedented move, MSD for Mothers awarded a second grant to South Africa for 2019. New grant holder the Faculty of Health Sciences at University of Pretoria will take over the reins from FPD and will implement Clever, which shifts the focus onto nursing staff. The intervention will better equip nursing staff to deal with maternal distress and improve the quality of care in midwife-led obstetric units and district hospitals. Like its predecessor, CLEVER aims to reduce maternal deaths, as well as stillbirths and the death of new-borns in their first week of life, and to improve the overall experience of birthing care for mothers – all while using existing resources.
The term Clever stands for:
“The Working Clever package was developed to reorganise the way in which obstetric care is provided at district level and to support and mentor midwives and other clinical staff to render high-quality, respectful obstetric care,” says Cathy Bezuidenhout, project manager, Research Centre for Maternal, Foetal, Newborn & Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria.
The intervention will also be rolled out to other districts in the country, with the focus on empowering local clinicians.
“Clever focuses on delivering high-quality maternity care at primary care facilities in South Africa, and to create a positive and happy childbirth experience,” Bezuidenhout says. “We are excited about this important and much-needed programme and the impact it can have on saving the lives of women and newborns. No woman should die in childbirth.”
