Reducing Maternal and Neonatal mortality in North West Province 14th SOMSA CONGRESS RIO Hotel Ms Grace Tsele

LAYOUT Introduction Background Institutional Maternal Mortality Primary Causes Interventions Progress (NCCEMD ) U/5 Mortality Neonatal mortality Progress General Challenges

INTRODUCTION “The quality of life of women and children particularly rural women, poor women and women from ethnic and indigenous minorities is a strong measure for a real change for the world’s most vulnerable people”- Kofi Annan A midwife – A first hand to touch, to love, guide the way, first helping hand, to calm and feed. Effective midwives must be clinically competent with required knowledge, skills and attitude to provide quality care. Their success depends on a supportive supervision, continuous education, enabling policies and access to resources

NW fertility rate ↓ from 3.11 (2001-2006) to 2.90 (2011-2016) BACKGROUND The North West Province has an estimated population size of 3,790,600. The total female population is estimated at 1,8655,610 of which 989 835 represent the number of women in reproductive age (15-49). U/5 population is at 358 046 NW fertility rate ↓ from 3.11 (2001-2006) to 2.90 (2011-2016)

SOCIAL DETERMINANTS North Western part of the country Boarders – FS,GP,Botswana,NC 4 Districts, 19 Sub-Districts, 383 municipality wards, 328 facilities Rural (West) – economic activities around agriculture and seasonal jobs Eastern part –host highly populated districts(Boj, KK)-mining, migrant labour, informal squatter settlements

HIV PREVALENCE PREVALENCE YEAR SA NW 2013 29.6 28.2 2014 30.0 28.6 2015 30.6 29.1

(Where are we from ?)NCCEMD 2008-2010)

Institutional MMR per province 2008-2010 Red line 15% above, green 15% below national average

NCCEMD REPORT PRIMARY CAUSES Non preg . related infections AVOIDABLE FACTORS : Patient: delay seeking medical help Administrative: transport Health Care Professional: Time of emergency >> ANC; PNC (sub-standard care), delayed referal, poor monitoring & no action; Lack of clinical supervision. PRIMARY CAUSES Non preg . related infections Obstetric haemorrhage HPT Medical and Surgical disorders and others Sepsis

NWP Specific actions for saving mothers lives 6 INTERVENTIONS ACCOUNT FOR 90% OF MATERNAL LIVES SAVED HOW MANY MOTHERS DIE (TOTAL) IN THE NWP – Source DHIS -12 May 2015- 2014-2015 FY

OTHER INTERVENTIONS CARMMA implementation MWH ESMOE and OEST BANC 9 Obstetric ambulances MMR meetings Maternity case records audits and Maternal Death assessors support Provincial MCWH forum

OTHER INTERVENTIONS PPH monograph C/S monograph Decentralization of High Risk Clinics

NCCEMD 2011-2013)

NO. OF U/5 DEATHS REGISTERED BY PROVINCE (STATS SA)

EARLY NEONATAL , LATE NEONATAL, AND POST NEONATAL MORTALITY RATES NW 1996-2005

INTERIM REPORT ON MORBIDITY AND MORTALITY IN CHILDREN UNDER 5 YEARS COMMIC :2012 INFANT MORTALITY RATE U/5 MORTALITY 2007 2008 2009 SA 47.4 44.7 38.1 62.1 59.8 50.7 North West 77.6 70.2 48.4 100.3 93.1 63.1

LEADING CAUSES OF DEATHS

NWP SPECIFIC ACTIONS FOR SAVING CHILD LIVES HOW MANY CHILDREN DIE (TOTAL) IN THE NWP – Source DHIS -4 June 2014 - 2013-14 FY 11 INTERVENTIONS ACCOUNT FOR 70% OF CHILD LIVES SAVED

2ND TRIENNIUM REPORT (COMMIC)

SPECIFIC ACTIONS FOR SAVING NEW-BORN LIVES 7 INTERVENTIONS ACCOUNT FOR 90% OF NEONATAL LIVES SAVED HOW MANY NEONATES DIE (TOTAL) IN THE NWP – Source DHIS -4 June 2014 - 2013-14 FY

OTHER INTERVENTIONS Training of Traditional leaders BANC PLUS KMC Human Milk Bank PMTCT Option B Plus Birth PCR HBB MSSN Interfacility transport Decentralised High Risk clinics

CHALLENGES CONT… High staff turn over Insufficient budget to replace staff Non compliance to protocols and guidelines – avoidable deaths

ACKNOWLEDGEMENTS Hon. MEC Dr Magome Masike for his leadership and support Maternal death assessors Provincial ministerial commitee members Provincial MCWH Forum Developmental partners Doctors and Midwives Civil society groups

I THANK YOU