The Millennium Development Goals (MDGs) represent a global partnership to reduce extreme poverty by setting out a series of time-bound targets, with a deadline of 2015. In 2000, world leaders made a historic commitment: at the United Nations Headquarters in New York to eradicate extreme poverty and improve the health and welfare of the world’s poorest people within 15 years. The commitment, adopted at the Millennium Summit in September 2000, was described in the United Nations Millennium Declaration . It was expressed in eight time-bound goals, known as the Millennium Development Goals (MDGs).
To assess where Guyana is in terms of the targets outlined, Stabroek News begins a series looking at goals 4 and 5: reducing child mortality and improving maternal health.
By Iana Seales
With a declining child mortality rate Guyana is nestled in a select category of countries which have achieved the target outlined for 2015, but the country’s health sector continues to face sharp criticisms for a maternal health programme that is yet to offer the type of care required and which has failed too many mothers.
Over the years there has been progress in both areas, improvements which the Ministry of Health has referred to in reports prepared and can take credit for. Still, Guyana like so many developing countries continues to struggle with the MDGs and is considered to be lagging behind in many critical areas such as maternal healthcare.
In fact, a United Nations draft report which was recently released ahead of an important summit in September pointed to uneven progress in some countries. The UN said it is particularly concerned that progress has been slow in improving maternal health and reducing maternal mortality, and it issued a call to rich nations to step up aid across the board if countries are going to meet the targets outlined for 2015. According to the UN conclusions, which Reuters reported on, the G8 plans to boost aid especially for maternal health and young children at a summit later this month in Canada. “Progress has been uneven and, without additional efforts, several of the Millennium Development Goals are likely to be missed in many countries”, the UN said.
Despite the progress here, deaths of children under five years continue to be recorded and while the numbers are not alarming the fact that infants are dying is. Health Minister, Dr. Leslie Ramsammy agrees, he told Stabroek News that the child mortality numbers though not very high continue to raise serious concerns. But it is the number of maternal deaths which are particularly worrying; some deaths Ramsammy said are preventable and the problem appears to be in the area of obstetrics.
He said that if Guyana is to effectively address the concerns in both areas, it needs to focus on obstetrics and continued training. For child mortality, the country has to address issues with vaccination and invest more in the immunization programme since according to Ramsammy, this is critical to significantly reducing the numbers. For maternal health, the concerns are greater and the focus has to be wider, and as the minister pointed out access needs to be expanded across the country. He admitted that in some areas outside of the city access is limited.
Child mortality
The reality is that a child born in a developing country is 13 times more likely to die within the first five years of life than a child born in an industrialized country with Sub-Saharan Africa accounting for about half the deaths of children under five in the developing world.
In Guyana, infants are dying from diarrhoea and acute respiratory infections. Other causes of infant deaths include pneumonia, malaria and measles, among other preventable diseases. Simple interventions such as oral rehydration therapy, insecticide-treated mosquito nets and vaccinations are critical services within every health sector and according to Ramsammy, Guyana has delivered in this area.
More than 60 percent of the under-five deaths in the country occur in the neo-natal period, which is classified as the first 28 days. “If a baby survives the first 28 days there is a good chance the child will survive”, he stated, adding another 30 percent of the deaths occur during infant mortality- which is from birth to under 1 year- old. “…We are on pace, but this calls for a number of things, particularly investment in a few areas. We need more funding to do what is required, but the health sector is working to achieve those targets”, Ramsammy added.
He said the health sector has seen a significant reduction in the number of child deaths over the past decade; the estimated figure was around 22 annually several years ago and at the end of last year the figure was tallied at 12. Ramsammy said that around 90 percent of births are supervised in this country, noting that even in some remote areas mid-wives are called to the homes of women who are ready to deliver; the target is to achieve above 95 percent.
The minister is of the view that the sector need to revisit “this whole area of training and step it up” with the aim of training every healthcare worker in obstetrics. He said that for MDGs 4 and 5, focus has to be placed on obstetrics since skilled healthcare workers have been recognized for improving the performance records of countries everywhere. Ramsammy believes it is possible to reduce the child mortality numbers to a single digit number this year and he pointed to the progress made in Berbice.
Health Ministry records show that neonatal mortality in Berbice has been reduced by some 40 percent in two years and according to the minister, healthcare workers in the region are following a uniformed policy, which is that no baby should go home before seeing a doctor and or paediatrician if possible.
Maternal healthcare
Mothers continue to lose their lives in this country and at unacceptably higher numbers in other countries; Ramsammy said he is concerned about what is happening here because some of the deaths are preventable. He said some pregnancies are high risk, but noted that the level of care which is required affords high risk patients the opportunity to go into labour without any deep fears.
Ramsammy noted that a change in attitudes and the required training “will turn things around”. He said reducing maternal deaths, but more importantly, preventing them is possible because it has also been done in Berbice. He pointed to the county saying it has implemented a strategy of focusing on pregnant women and monitoring their conditions closely- resulting in a sharp decline in the region. About two maternal deaths are recorded in the region annually, some years no deaths are registered out of the region. However, Berbice does refer maternal patients to the city.
Pregnant mothers need to be monitored regularly, Ramsammy said, noting that the clinical audits are being done to fact-check what is happening in the system. “We have rules, the health workers say they are following the rules, are they?” he asked. He said hospitals also need to test for blood sugar levels and monitor women who develop gestational diabetes every carefully because some pregnancies are considered high-risk.
Nutrition is also critical and he pointed out that this country is not doing too well on the breastfeeding programme. However, he said healthcare workers can only insist that every mother breastfeed, but stressed they have no real way of ensuring that it happens. “We are in the stadium period of the race right now”, he said referring to the deadline target for the MDGs, and pointed out that many women are still not joining clinics early enough.
Guyana is doing well in the third trimester, he said, noting that a few women still only show up when they are ready to deliver their babies; the first trimester is where the problem is because some women are waiting until the third trimester to join a clinic. There are around 16 maternal deaths a year in this country, down from a figure of around 34 just over a decade ago. Ramsammy said Guyana has reduced maternal mortality by over 70 percent already, but the UN the goal is set at a target of reduction by 75 percent. Family planning continues to pose a challenge, he said, noting that people are not using contraceptives which are being provided free of cost.
He pointed out that adolescent pregnancies are also an area of some concern; around 22 percent of local deliveries have been to teenagers. He contended that the country needs to improve its record in this area and implement an effective public awareness campaign to get girls to stop rushing into pregnancies. Adolescent pregnancies are often plagued with complications and though more young women are staying in schools longer, in addition to moving on to tertiary education, Ramsammy said the teenage pregnancy numbers have been consistent over the years.
Further, he said women need to space their babies out better, noting that a high percentage still get their babies in a cluster, which also poses challenges.