The bumpy road to improve maternal mortality
February 2010; Nepal is very close to achieving the maternal health goal, but there is a budget gap to put the commitments fully into action. The government is committed to increasing health sector budget gradually and allocate at least 7 per cent of the national budget by 2008-09. The total budget in the health sector increased from Rs 14.9 billion in 2008-09 to Rs 17.8 billion in 2009-10. As yet, the allocation for the health sector reached only 6.3 per cent of the national budget.
There is a severe shortage of maternal health services, especially in the hills, where most of the maternal deaths occur. Skilled Birth Attendants (SBA) are present in only 19 per cent of deliveries. The government targets to bring the deliveries attended by SBA up to 60 per cent and train 5,000 SBAs to achieve the Millennium Development Goals (MDGs) and bring down the maternal deaths to 134 per 100,000 by 2015, currently it being 281 per 100,000. The government has been training 800 SBAs every year since 2008-2009.
Safe Motherhood and Neonatal Health - 2017, aims to set up birthing centres in at least 70 per cent of the total 711 health posts and provide essential obstetric care and abortion services in 80 percent of the 180 primary health centres. "This requires additional budget and skilled human resources. But if we are able to set up a birthing centre in health posts, train 5000 additional SBAs by 2012 as planned as well as fund communities to mobilise transportation during emergency then we will be able to meet the target," says Binjwala Shrestha, the Monitoring and Evaluation Chairperson of the Federation for Safe Motherhood Network Nepal.
Dr B.K Suvedi, director of Family Health Division of the Ministry of Health says, "Efforts are on to meet the MDGs. If everything goes smoothly including political will, budget and commitment, then we will have adequate trained human resources to achieve the target."
However, the community members in general and women in particular should also be empowered to demand the services they are entitled to. Unless women are empowered both socially and financially to make decisions about their reproductive health, the efforts will not be effective. Many women are still unaware of the available facilities in their communities.
Health experts blame three main reasons for the bleak mortality rate and refer them as 'three delays'. As many as 67.4 per cent of the women giving birth die at home due to delay in taking the decision to seek medical assistance; 11.4 per cent die due to delay in accessing appropriate care; and 21.1 per cent die due to delay in accessing the appropriate care at the health centres.
The United Nations Millennium Campaign (UNMC) Nepal is working with the local bodies, namely the National Association of VDCs in Nepal (NAVIN) and Municipal Association of Nepal (MuAN) to develop and implement a citizen monitoring and tracking program based on local tracking tools to empower women in rural areas and their families to become aware and to avail themselves of these facilities. The program is being piloted in Rayale and Nallu villages and will be implemented in 6 more villages in 2010.
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